动脉灌注化疗联合CT引导下放射性125I粒子植入术治疗中晚期胰腺癌的临床研究

目的 探讨经动脉灌注化疗(transarterial chemotherapy,TAC)联合CT引导下的放射性125I粒子植入术治疗中晚期胰腺癌的临床疗效及应用价值.方法 将57例不能手术切除的中晚期胰腺癌患者随机分成2组,进行前瞻性随机对照研究,分别采用动脉灌注化疗联合CT引导下的放射性125I粒子植入术(30例)及全身静脉化疗(27例),比较TAC联合125I粒子植入和单纯静脉化疗治疗中晚期胰腺癌的效果,评价其疗效和安全性.结果 临床受益疗效治疗组为60.0%(18/30),而对照组为25.9%(7/27);肿瘤治疗客观有效率治疗组为36.6%(11/30),对照组为11.1%(3/27).中位生存期:治疗组为296 d,对照组为189 d.结论 TAC联合125I粒子植入术疗效明显优于较单纯静脉化疗,TAC联合125I粒子植入术是治疗中晚期胰腺癌较为有效的方法.     

125^I粒子植入联合动脉灌注化疗治疗不可切除性肺癌

目的 探讨CT引导下125I粒子植入联合动脉灌注化疗治疗不可切除肺癌的价值.方法 30例不可切除性肺癌患者随机分为两组.A组14例,125I粒子植入术前或后1周内行动脉灌注化疗;B组16例,单纯125I粒子植入治疗.两组患者125I粒子植入2个月后行胸部CT检查,按RECIST标准判定疗效并进行生存分析.结果 30例患者全部按计划完成治疗.A组植入粒子552枚,9例行了2次动脉灌注化疗;B组共植入125I粒子603枚.CT复查显示:A组完全缓解(CR)0例,部分缓解(PR)10例,稳定(SD)4例,进展(PD)0例,治疗有效率为71.4%;B组完全缓解(CR)0例,部分缓解(PR)10例,稳定(SD)5例,进展(PD)1例,治疗有效率为62.5%.两组治疗有效率差异无统计学意义(P＞0.05).1年生存率分别为78.6%和 62.5%,生存期差异有统计学意义(P＜0.05).结论 125I粒子植入联合动脉灌注化疗是治疗不可切除性肺癌的一种有效方法,可显著延长患者的生存期.     

CT引导下~(125)I放射性粒子治疗胰腺癌的疗效观察

目的 探讨CT引导下~(125)I放射性粒子植入治疗胰腺癌技术的可行性和疗效.方法 对40例不能手术切除的晚期胰腺癌患者作CT引导下植入~(125)I粒子治疗.术前采用治疗计划系统(TPS)重建胰腺肿瘤的三维立体图像,计算出植入的~(125)I粒子数目、空间分布和剂量分布率,在CT引导下将~(125)I粒子植入胰腺肿瘤内,采用~(125)I粒子活度为0.5～0.8 mCi/颗,相隔1.0 cm植入,避开血管和胰管等周围重要脏器.放射性粒子的肿瘤匹配周边剂量(matched peripheral dose,MPD)为60～140 Gy.中位植入粒子36颗(18～68颗),术后即刻行CT扫描进行粒子质量验证.术后1周10例患者给予吉西他滨和5-Fu动脉灌注化疗,3～4个疗程.结果 全组肿瘤平均直径为4.9 cm.治疗后随访2～28个月,术后患者顽固性疼痛症状明显缓解(P<0.05),Karnofsky评分显著提高(P<0.05).平均术后2～5 d疼痛开始缓解.术后2个月CT随访,肿瘤完全缓解(CR)3例,部分缓解(PR)20例,无变化(NC)14例,进展(PD)3例.总有效率(CR+PR)为57.5%.全组中位生存时间为10.2个月.Ⅱ、Ⅲ、Ⅳ期粒子植入术后中位生存期分别为14.7、10.9及7.1个月;6个月和12个月累计生存率分别为100%、88%、62%和70%、41%、0.其中5例合并肝转移患者,则同时行动脉栓塞治疗.3例患者术后随访发现4颗粒子迁移到肝脏内.在随访过程中未见上消化道出血、胰腺炎、胰瘘及放射性肠炎等并发症.结论 CT引导下植入~(125)I放射性粒子治疗胰腺癌,近期疗效确切,具有良好的止痛效果,是一种安全、有效、并发症发生率低的微创治疗方法,粒子治疗后联合化疗药物动脉灌注治疗,有望提高疗效,远期疗效尚待进一步随访和观察.     

CT导向下125Ⅰ粒子植入治疗肾上腺恶性肿瘤

目的 探讨CT导向下125I粒子植入治疗肾上腺恶性肿瘤的疗效.方法 回顾性分析行CT导向下125I粒子植入治疗的9例肾上腺恶性肿瘤患者(9个病灶).采用治疗计划系统(TPS)模拟布源.在CT导向下将125I放射性粒子置入肾上腺肿瘤内.单个粒子的放射性活度为29.6 MBq,粒子相隔1.0 ～ 1.5 cm平面播植.治疗...     

CT引导下125Ⅰ粒子植入治疗难治性盆腔恶性肿瘤

目的评价CT引导下^125I粒子组织间植入治疗盆腔难治性恶性肿瘤的临床疗效，探讨粒子植入技术。方法23例盆腔恶性肿瘤，均为术后复发接受化疗和（或）根治量放疗肿瘤仍进展患者，瘤体最大径3.5—7．0cm，平均4．5cm。粒子植入术前1～3d行模拟CT扫描，采用治疗计划系统（TPS）制定粒子植入计划，根据处方剂量求出术中所需^125I粒子的总活度并算出治疗粒子数量。在CT引导下经皮穿刺植入^125I粒子。其中6例患者粒子植入前或后接受髂内动脉灌注化疗。结果单个瘤体内首次植入粒子数为9～75粒，平均27粒。6例接受髂内动脉灌注化疗共14个疗程。粒子植入术后72h～4周，下肢疼痛和（或）肛门、会阴周围疼痛坠胀不适，完全缓解5例，部分缓解11例，有效率69．6％（16／23）。术后随访2～34个月，中位随访21个月，部分缓解（PR）18例；无变化（SD）4例；进展（PD）1例，总有效率78．3％（18／23）。死亡3例，存活20例，最长生存时间34个月。结论CT引导下^125I粒子植入对盆腔难治性恶性肿瘤安全、有效。     

CT导引下125Ⅰ粒子组织间植入联合支气管动脉灌注化疗治疗肺癌

目的评价CT导引下125Ⅰ粒子组织间植入联合经支气管动脉灌注化疗治疗进展期肺癌的疗效和安全性。方法 108例Ⅲ～Ⅳ期肺癌患者随机分为联合治疗组和灌注化疗组,联合治疗组43例57个病灶接受CT导引下125Ⅰ放射性粒子植入后,联合同步支气管动脉内GP方案化疗2～4个周期,灌注化疗组65例患者74个病灶仅接受支气管动脉内GP方案化疗2～4个周期,比较两组患者的疗效和毒性反应的发生率。结果 1、3、6、12个月两组总缓解率分别为8.8%、56.1%、63.6%、84.0%和2.7%、21.0%、41.9%、45.1%,差异有统计学意义(P<0.01或P<0.05)。联合治疗组和灌注化疗组1年累计生存率分别为91%和65%,中位生存时间分别为533天和422天,差异有统计学意义(P<0.01)。CT导引下125I粒子植入的主要并发症为气胸、咯血、放射性粒子游走和胸腔积血,化疗主要的毒性反应为骨髓抑制和胃肠道反应等,患者可以耐受,联合治疗组和灌注化疗组患者各化疗毒副反应的总发生率差异均无统计学意义(均P>0.05)。结论 CT导引下125I粒子组织间植入联合经支气管动脉灌注化疗治疗肺癌是一种安全、有效、微创的治疗方法。     

CT导向下~(125)I粒子植入治疗肾上腺恶性肿瘤

目的 探讨CT导向下125I粒子植入治疗肾上腺恶性肿瘤的疗效.方法 回顾性分析行CT导向下125I粒子植入治疗的9例肾上腺恶性肿瘤患者(9个病灶).采用治疗计划系统(TPS)模拟布源.在CT导向下将125I放射性粒子置入肾上腺肿瘤内.单个粒子的放射性活度为29.6 MBq,粒子相隔1.0 ～ 1.5 cm平面播植.治疗后1 ～ 15个月,复查增强CT扫描进行影像学疗效评价.结果 9例患者125I粒子植入治疗后肿瘤获得不同程度缓解,影像评价:完全缓解5例,部分缓解3例,无变化1例.治疗操作的主要并发症为少量出血(1例).结论 CT导向下125I粒子植入治疗肾上腺恶性肿瘤近期疗效确切,是一种安全、有效的微创介入治疗方法.     

CT引导下~(125)Ⅰ粒子植入治疗难治性盆腔恶性肿瘤

目的评价CT引导下125Ⅰ粒子组织间植入治疗盆腔难治性恶性肿瘤的临床疗效,探讨粒子植入技术。方法23例盆腔恶性肿瘤,均为术后复发接受化疗和(或)根治量放疗肿瘤仍进展患者,瘤体最大径3.5～7.0 cm,平均4.5 cm。粒子植入术前1～3 d行模拟CT扫描,采用治疗计划系统(TPS)制定粒子植入计划,根据处方剂量求出术中所需125Ⅰ粒子的总活度并算出治疗粒子数量。在CT引导下经皮穿刺植入125Ⅰ粒子。其中6例患者粒子植入前或后接受髂内动脉灌注化疗。结果单个瘤体内首次植入粒子数为9～75粒,平均27粒。6例接受髂内动脉灌注化疗共14个疗程。粒子植入术后72 h～4周,下肢疼痛和(或)肛门、会阴周围疼痛坠胀不适,完全缓解5例,部分缓解11例,有效率69.6%(16/23)。术后随访2～34个月,中位随访21个月,部分缓解(PR)18例;无变化(SD)4例;进展(PD)1例,总有效率78.3%(18/23)。死亡3例,存活20例,最长生存时间34个月。结论CT引导下125Ⅰ粒子植入对盆腔难治性恶性肿瘤安全、有效。     

The Analysis of Curative Effect of Combined Treatment of CT Guided Percutaneous 125I Seed Implantation with Bronchial Arteral Infusion Chemotherapy for Lung Cancer

目的 评价CT导引下125I粒子组织间植入联合经支气管动脉灌注化疗治疗进展期肺癌的疗效和安全性.方法 108例Ⅲ～Ⅳ期肺癌患者随机分为联合治疗组和灌注化疗组,联合治疗组43例57个病灶接受CT导引下125I放射性粒子植入后,联合同步支气管动脉内GP方案化疗2～4个周期,灌注化疗组65例患者74个病灶仅接受支气管动脉内GP方案化疗2～4个周期,比较两组患者的疗效和毒性反应的发生率.结果 1、3、6、12个月两组总缓解率分别为8.8％、56.1％、63.6％、84.0％和2.7％、21.0％、41.9％、45.1％,差异有统计学意义(P＜0.01或P＜0.05).联合治疗组和灌注化疗组1年累计生存率分别为91％和65％,中位生存时间分别为533天和422天,差异有统计学意义(P＜0.01).CT导引下125I粒子植入的主要并发症为气胸、咯血、放射性粒子游走和胸腔积血,化疗主要的毒性反应为骨髓抑制和胃肠道反应等,患者可以耐受,联合治疗组和灌注化疗组患者各化疗毒副反应的总发生率差异均无统计学意义(均P＞0.05).结论 CT导引下125I粒子组织间植入联合经支气管动脉灌注化疗治疗肺癌是一种安全、有效、微创的治疗方法.     

CT引导下125I粒子永久植入治疗肝转移癌

目的探讨CT引导下125I粒子植入治疗在肝转移癌治疗中的意义。方法 2007年8月～2008年10月31例结肠癌肝转移患者,共67个转移灶,均采用CT导向下125I放射性粒子植入,粒子植入之前采用治疗计划系统(treat-ment planning system,TPS)模拟布源或遵循Halarism的125I经验公式(mCi=Da×5),粒子按照0.5～1.0cm平面插植。在螺旋CT导向下将125I放射性粒子植入肝转移癌实质内及肿瘤边缘。结果治疗后2个月进行肿瘤影像学评价,31例患者中,完全缓解(complete remission,CR)7例,部分缓解(partial remission,PR)15例,稳定(no change,NC)9例。全组31例目前全部存活,随访时间最长14个月,最短6个月,近期平均生存期10.5个月。结论 CT导向下125I粒子植入治疗肝转移癌疗效确切、创伤小、并发症少,是一种比较安全、微创、有效的方法。     

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     

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.     

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.     

人体中的镭-226、镭-228、钋-210、铅-210

本文报道了广东阳江高本底地区6名、对照地区8名人尸体的骨²²⁶Ra、²²⁶Ra的浓度以及部分居民内脏器官中。²¹⁰Po、²¹⁰Pb的浓度。结果轰明阳江高本底地区和对照地区居民骨镭-226、镭-228的浓度分别为29.9pCi/kg, 26.9pCi/kgl 8.7pCi/kg, 8.2pCi/kg.由此估算出阳江高本底地区屠民骨中²²⁶Ra、²²⁸Ra的负薄璧及对骨衬、骨髓所产生的剂量当量分别为对照地区民民的3.4倍, 3.3倍。两地区居民内脏器官中^{210Po、210Pb的测定分析铡数较少但仍看出, 高本底地区均明显高于对照地区.}     

磁共振DWI和动态增强鉴别颅底脊索瘤和侵袭性垂体瘤的应用

目的 探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值.方法 搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例.测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值.结果 颅底脊索瘤的ADC值为(1.274±0.07)×10-3mm2/s,高于IPA ADC值(0.672±0.03) ×10-3 mm2/s(P ＜0.001),ADC阈值为0.964×10-3mm2/s时,ROC曲线下面积为0.997,敏感度为93.3％,特异度为100％.颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TIC Ⅰ型7例,TICⅢ型13例.颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P ＜0.001).结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别.