静脉全身麻醉在经皮肝穿刺胆道引流术中的应用

目的 通过局部麻醉与静脉全麻比较,探讨静脉全麻在经皮经肝胆道引流(PTBD)手术中的安全性与有效性.方法 收集2012年10月至2015年8月125例行PTBD治疗患者的临床资料.其中48例患者采用局部麻醉,77例采用静脉全麻.观察患者术中及术后疼痛情况、心率及血压,随访观察手术操作时间,患者术后疼痛持续时间及穿刺相关并发症发生率.结果 静脉全麻组术中仅5例(6.5％)出现轻度疼痛,术后8例(10.4％)轻度疼痛,明显低于局部麻醉组(P＜0.01),疼痛评分亦低于局部麻醉组(P＜0.05).局部麻醉组术中患者心率、血压较术前、术后明显升高且波动较大,静脉全麻组术中患者心率、血压较术前、术后降低,但波动较小.局部麻醉组手术操作时间长于静脉全麻组(P＜0.05).静脉全麻组术后疼痛持续时间明显短于局部麻醉组(P＜0.05).手术相关并发症方面,局麻组3例患者发生肝动脉损伤,2例出现胆心反射综合征,2例出现胸膜损伤,静脉全麻组仅2例出现肝动脉损伤,无患者出现其他手术相关并发症.2组患者均无手术相关性死亡.结论 PTBD术中应用静脉全麻可有效降低手术风险,缩短手术时间并减轻手术痛苦,增加舒适性,值得临床应用推广.     

恶性梗阻性黄疸的介入治疗

目的：评价经皮肝胆道引流术（PTBD）在恶性梗阻性黄疸疾病中的应用价值。方法：对14例不能手术的恶性胆道梗阻患者行PTBD术，其中高位梗阻12例，胆总管下段梗阻2例。结果：14例行PTBD术，手术成功率100％。一次穿刺成功率85．7％（12／14）。所有患者术后2W血清胆红素较术前减少1／2以上，黄疸明显减退。结论：PTBD能有效地降低不能手术治疗的恶性黄疸病人的血清胆红素，是恶性梗阻性黄疸患者术前减轻黄疸与姑息性治疗的有效方法。     

盐酸哌替啶联合山莨菪碱在梗阻性黄疸介入干预术中的应用

目的 探讨盐酸哌替啶与山莨菪碱配伍应用在晚期恶性梗阻性黄疸患者肝穿胆道引流术(PTCD)及支架植入术(PTBS)中的应用效果.方法 因恶性梗阻性黄疸行PTCD及PTBS的100例患者,随机分成对照组与研究组,每组50例.研究组于术前30 min联合分别肌注盐酸哌替啶100 mg与山莨菪碱10 mg,对照组术前术中不用镇痛药及解痉药,观察患者血压和心率,记录胆心反射发生率及手术时间,应用疼痛评分量表评定患者疼痛程度.结果 与对照组相比,盐酸哌替啶与山莨菪碱配伍应用能稳定研究组患者生命体征、缩短手术时间、减少胆心反射发生率、缓解疼痛,提高患者舒适度.结论 盐酸哌替啶与山莨菪碱配伍应用于晚期恶性梗阻性黄疸患者PTCD或PTBS介入术中,可缓解疼痛,节省手术时间,方法简便易行、安全有效、费用低廉,可以作为PTCD或PTBS介人手术前的常规用药.     

经皮肝穿刺胆道引流术及胆管内支架植入术在恶性梗阻性黄疸治疗中的应用

目的 评价经皮肝穿刺胆道引流(FTBD)及胆管内支架植入术(PTIBS)治疗恶性梗阻性黄疸的疗效.方法 对56例恶性梗阻性黄疸患者采取PTBD或PTIBS,所有患者均经B超、CT或MRI明确诊断,并确定梗阻部位,其中高位梗阻19例,低位梗阻37例.梗阻原因包括肝癌14例,胆管癌11例,胆囊癌5例,胃癌伴淋巴结转移14例,壶腹部占位1例,胰头癌11例.术中根据造影结果选择合适方案.结果 所有56例均成功完成手术.其中行PTBD 11例,PTIBS 40例,PTBD并PTIBS 5例.TBIL由术前(295.65 ±152.86)μmol/L降至术后(151.05 ± 107.36)μmol/L(P<0.01).术后感染对黄疸消退有影响(P<0.01).梗阻部位与黄疸消退情况比较差异无统计学意义(P=0.063).结论 经皮肝穿刺胆道引流及支架植入术治疗恶性梗阻性黄疸安全有效,可明显减轻黄疸,改善患者生活质量,延长生存期.     

恶性梗阻性黄疸介入治疗短期预后的多因素分析

目的 探讨影响恶性梗阻性黄疸经皮肝穿胆道引流或(和)胆道支架置入术近期预后的相关因素.方法 分析2008年12月至2009年6月经PTBD或(和)PTBS治疗的梗阻性黄疸患者67例,参照胆红素下降程度和术后30 d内生存情况分为短期治疗有效(54例)和无效(13例)2组,应用X~2进行单因素分析,非条件Logistic进行多因素分析.结果 单冈素分析方法显示患者梗阻时间、引流方式、术前胆道感染和肝功能Child-Pugh评分、TBIL、HGB、Cr 7个因素有统计学意义.多因素分析示术前胆道感染、肝功能Child-Pugh评分≥11分、Cr>115 μmol/L3个因素有统计学意义.结论 术前胆道感染、肝功能Child-Pugh评分≥11分、Cr>115μmol/L与梗阻性黄疸短期预后关系密切,对梗阻性黄疸介人治疗的术前评估有重要参考意义.     

经皮肝穿刺胆汁引流术治疗恶性梗阻性黄疸临床分析

经皮经肝穿刺胆汁引流术(PTBD)是恶性梗阻性黄疸常见姑息性治疗方法[1].本院自1997-08-2007-08对78例有完整资料的恶性梗阻性黄疸患者行PTBD术,术后治疗效果满意,现总结如下.     

胃癌合并梗阻性黄疸经皮经肝胆道引流术后中、长期疗效分析

目的 探讨胃癌合并梗阻性黄疸患者经皮经肝胆道引流(PTBD)术后疗效、并发症及影响生存质量的因素.方法 回顾性分析了28例因胃癌合并梗阻性黄疸于我科行PTBD治疗患者的临床资料,通过电话、门诊以及病历回顾等方式随访.结果 PTBD术后25例患者胆红素水平明显下降,肝功能改善,临床症状缓解.主要并发症包括胆道感染、胰腺炎...     

X线透视联合超声引导行经皮肝穿胆道引流术治疗梗阻性黄疸的临床应用

目的分析X线透视联合超声实时引导下经皮肝穿胆道引流术(PTBD)治疗阻塞性黄疸的操作技术及其应用价值。方法 78例阻塞性黄疸患者,其中70例为恶性阻塞性病变,8例为良性阻塞性病变,在超声实时引导结合X线透视下行PTBD术,穿刺右叶胆管52例,穿刺左叶胆管26例,并常规造影。结果所有患者手术均获得成功,未出现大出血及胆汁性腹膜炎等并发症,术后梗阻性黄疸症状逐渐改善,术后1～2周血清胆红素及转氨酶水平较术前明显下降(P<0.01)。结论 X线透视结合超声实时引导下PTBD是一种治疗阻塞性黄疸的有效方法,具有安全、简便、经济、并发症少的优点。     

恶性梗阻性黄疸经皮肝穿刺胆道引流术后院内死亡危险因素探讨

目的 探讨与恶性梗阻性黄疸患者经皮肝穿刺胆道引流术(PTBD)后院内死亡相关的独立的术前、术中及术后危险因素.方法 因恶性梗阻性黄疸第1次行PTBD引流155例患者纳入本研究,根据术后30 d内患者死亡情况分为院内死亡组和生存组,应用单因素和多因素分析对25个术前、4个术中和6个术后潜在的与院内死亡相关的危险因素进行分析,连续变量比较应用t检验,分类变量应用x2检验;将单因素分析筛选出的可能危险因素再进行多因素Logistic分析.结果155例患者中26例于术后30 d内死亡(16.8％),即院内死亡组;其余129例为生存组.单因素分析显示25个术前潜在的危险因素中9个具有统计学意义,再对其进行多因素分析显示肝功能分级C级[比值比(OR)为4.024,95％置信区间(CI)为1.432 ～ 11.307,P＜0.05]、患者生活质量评分≤30分(OR为8.688,95％ CI为2.788 ～ 27.079,P＜0.05)和肌酐≥6.93 μmol/L(OR为5.102,95％ CI为1.798 ～14.478,P＜0.05)为具有统计学意义的危险因素.单因素及多因素分析显示4个术中潜在的危险因素均无统计学意义;单因素分析显示6个术后潜在的危险因素中3个具有统计学意义,继续进行多因素分析显示PTBD术后胆道感染(OR为6.239,95％CI为2.289 ～16.999,P＜0.05)和引流不成功(OR为7.467,95％CI为2.481 ～22.475,P＜0.05)为具有统计学意义的危险因素.结论 3个术前和2个术后危险因素与恶性梗阻性黄疸患者院内死亡的发生有关.     

支气管动脉栓塞术围手术期迷走神经反射的回顾性临床分析

目的：探讨大咯血患者支气管动脉栓塞术(BAE)围手术期迷走神经反射的原因及处理方法。方法收集本院大咯血患者112例,其中9例在介入栓塞术围手术期出现迷走神经反射。结果9例均表现为混合型迷走神经反射,5例迷走神经反射出现在支气管动脉栓塞过程中,1例出现在术毕拔鞘过程中,1例出现在压迫止血过程中,2例出现在患者刚返回病房后。经阻断迷走神经、升压、扩容等对症处理后好转,未出现死亡等严重不良后果。结论 BAE 围手术期迷走神经反射与患者紧张度过高、不规范操作密切相关,一旦发现迷走神经反射,及时予以阿托品阻断迷走神经,必要时升压、扩容处理。     

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.