α-氰基丙烯酸正丁酯栓塞治疗急性非肿瘤性小肠出血的安全性和疗效评价

【摘要】 目的 评价α-氰基丙烯酸正丁酯（NBCA）经导管动脉栓塞治疗急性非肿瘤性小肠出血的安全性和有效性。 方法 回顾性分析2013年1月至2020年6月单中心采用NBCA胶经导管动脉栓塞治疗的15例急性非肿瘤性小肠出血患者临床资料和随访结果。其中男6例,女9例,年龄21～85岁。通过手术技术成功率、临床有效率、手术相关并发症和复发率评价NBCA胶栓塞治疗急性非肿瘤性小肠出血的安全有效性。 结果 15例患者中DSA造影表现为对比剂渗出8例,动静脉畸形3例,动脉瘤4例。所有患者均成功应用NBCA胶栓塞,技术成功率为100%。术后13例止血成功,临床有效率为86.7%。术后腹痛4例,未出现栓塞所致肠坏死需外科急诊处理。3例随访期出血复发,复发率为23.1%（3/13）。结论 NBCA在急性非肿瘤性小肠出血栓塞治疗中有较高的安全有效性,更可靠的结论需要大样本随机对照研究证实。     

α- 氰基丙烯酸正丁酯胶栓塞肝胆胰外科术后出血的安全性和有效性

【摘要】 目的 评价采用α-氰基丙烯酸正丁酯(NBCA）胶栓塞治疗肝胆胰外科术后出血的安全性和有效性。 方法 回顾性分析2019年1月至2021年8月采用NBCA胶栓塞治疗的19例肝胆胰外科术后出血患者临床资料、技术成功率、临床成功率及并发症。 结果 19患者中男17例,女2例,年龄26～80岁。血管造影发现对比剂外溢15例,假性动脉瘤3例,肝动脉瘤样扩张1例。技术成功19例,临床成功15例。未发生介入治疗相关严重并发症。 结论 采用NBCA胶栓塞治疗肝胆胰外科术后出血安全有效,尤其是对肝动脉、脾动脉破裂大出血患者,具有快速止血的优势。     

α-氰基丙烯酸正丁酯在选择性肝动脉栓塞中的应用

目的:评价应用α-氰基丙烯酸正丁酯(N-butyl 2-cyanoacrylate,NBCA)选择性栓塞肝动脉的安全性和有效性.材料和方法:2008-09～2009-12解放军总医院就诊的20例患者,包括外科术后出血2例、原发性肝癌合并肝动-静脉瘘形成11例、多囊肝7例,男性13例,女性7例;年龄45-65岁,应用NBCA进行选择性肝动脉栓塞.结果:所有选择性栓塞均成功,无严重并发症.2例外科术后出血患者在栓塞结束后出血即停止,分别随访6个月、8个月,均未再发生出血.11例原发性肝癌合并肝动-静脉瘘患者中9例患者瘘口闭合,2例患者瘘口明显缩小.7例多囊肝患者栓塞区囊肿范围均不同程度缩小.结论:应用NBCA进行选择性肝动脉栓塞的近期疗效是安全、可靠的,但其栓塞的远期效果仍有待进一步观察.     

以NBCA栓塞治疗门脉高压性上消化道出血

目的研究以NBCA(N-Butyl-2-Cyanoacrylate)栓塞治疗晚期肝病所致门脉高压性上消化道出血的可行性。方法17例门脉高压性上消化道出血患者,皆显示胃冠状静脉、胃底静脉曲张,并显示脾-肾分流3例,胃-肾分流3例。9例择期手术,8例急诊手术。由右腋中线经右肝入路7例,由剑突下经左肝入路4例,经脾静脉入路6例,NBCA与超液化碘油比例为1∶4,栓塞程度以曲张静脉消失为目的。随访观察患者的生存期、症状改善情况等。结果17例患者手术全部成功,栓塞后造影显示曲张静脉完全闭塞,栓塞后门脉压力较术前平均升高3cmH2O,术中仅1例患者出现刺激性咳嗽,未发生与手术相关的严重并发症。术后1个月内患者症状均明显改善,未发生消化道出血、顽固性腹水等症状,复查CT增强扫描显示曲张静脉消失。随访3～12个月,患者生存期平均超过5个月,随访期内4例患者死亡,死亡原因主要为肝功能衰竭,其中3例患者合并少量消化道出血。结论以NBCA栓塞治疗晚期肝病导致门脉高压性消化道出血技术可行,疗效可靠,并发症少,严格地选择适应证能明显提高远期疗效。     

医用胶栓塞肾脏假性动脉瘤疗效分析

目的：探讨液体医用胶结合微导管超选择插管技术栓塞治疗肾脏假性动脉瘤的安全性及有效性。方法回顾性分析2009年10月至2014年1月肾动脉造影诊断为肾脏假性动脉瘤并接受福爱乐医用胶栓塞出血血管的23例患者临床资料。23例患者有28枚肾脏假性动脉瘤（18例医源性损伤患者有21枚,5例外伤患者有7枚）,均经3 F微导管超选择插管至肾脏假性动脉瘤载瘤动脉,造影明确后在减影下经微导管向假性动脉瘤内注入福爱乐医用胶－碘化油1∶1混合液栓塞出血血管。观察假性动脉瘤栓塞成功率、术后血尿及肾功能。结果23例28枚肾脏假性动脉瘤均栓塞成功,福爱乐医用胶平均用量0．4 ml（0．2～1 ml）。3例患者载瘤动脉邻近3级分支血管出现异位栓塞,无2级分支血管及肾动脉主干血管异位栓塞。1例假性动脉瘤直径＞2 cm患者术后2 d持续存在血尿,再次造影后于载瘤动脉补充塔形弹簧圈1枚,出血停止。其余患者在3个月随访期间均未再出现血尿情况。4例术后血清肌酐有轻度升高。结论福爱乐医用胶结合微导管超选择插管栓塞肾脏假性动脉瘤迅速,栓塞成功率高,术后再出血发生率低,疗效确切。     

脑动静脉畸形合并动脉瘤的血管内治疗

目的　回顾性总结脑动静脉畸形 (AVM)合并动脉瘤的血管内治疗经验 ,探讨其治疗策略、治疗方法等。方法　分析 5 1例脑AVM合并动脉瘤患者脑血管造影所见 ,根据动脉瘤所处部位结合临床病史决定治疗策略 ,在全麻下采用不同栓塞材料和导管通常先针对动脉瘤进行血管内治疗 ,并有计划地消除剩余病灶。结果　 6例Willis环动脉瘤 ,已出血的 4例先栓塞动脉瘤后栓塞AVM ,2例随访 ;16例供血动脉动脉瘤 ,11例采用弹簧圈栓塞 ,4例直接用NBCA胶栓塞 (2例发生术中动脉瘤破裂并发症 ) ,1例用Onyx胶栓塞 ;2 9例畸形团内动脉瘤 2 8例用NBCA胶栓塞 ,1例用Onyx胶栓塞。 2 2例随访或 1～ 3个月 2次治疗时造影显示动脉瘤栓塞结果稳定。结论　从本组的经验来看 ,AVM血流相关的Willis环动脉瘤已出血者需先治疗 ,未出血者随访 ;供血动脉动脉瘤需先栓塞治疗后再在该供血动脉内注胶 ;畸形团内动脉瘤是栓塞该AVM时应先考虑栓塞的目标。     

医用胶在外周动脉假性动脉瘤栓塞中的应用

目的 探讨医用胶在外周动脉假性动脉瘤(PSA)栓塞治疗中的安全性、有效性.方法 回顾性分析明确为外周动脉PSA并运用福爱乐医用胶栓塞患者25例.25例患者中有28枚PSA.19例患者(共22枚PSA)经3F微导管超选择插管至PSA载瘤动脉,6例患者(共6枚PSA)直接穿刺PSA,均在减影下向PSA内注入福爱乐医用胶+碘化油混合液(比例为1：1)栓塞PSA.观察PSA栓塞效果及有无并发症.结果 28枚PSA均栓塞成功,福爱乐医用胶平均用量1.8 mL(0.5~5.5 mL).1例>2 cm PSA术后2 d持续存在血尿,再次造影后于载瘤动脉补充微弹簧圈1枚,出血停止.1例肱动脉PSA患者行第2次栓塞后出血停止.术中及术后未出现治疗相关并发症,随访3个月均未再次出现出血情况.结论 福爱乐医用胶与碘油混合液栓塞外周动脉PSA成功率高,栓塞迅速,疗效确切.     

脑动静脉畸形合并动脉瘤的血管内治疗

目的　回顾总结 2 4 0例脑动静脉畸形 (AVM)中合并动脉瘤 5 1例的血管内治疗经验 ,探讨其治疗策略、治疗方法等。方法　分析研究造影所见 ,根据动脉瘤所处部位结合临床病史决定治疗策略 ,在全麻下采用不同栓塞材料和导管通常先针对动脉瘤进行血管内治疗 ,并有计划地消除剩余病灶。结果　 6例Willis环动脉瘤 ,已出血的 4例先栓塞动脉瘤后栓塞AVM ,2例随访 ;1 6例供血动脉动脉瘤 ,1 1例采用弹簧圈栓塞 ,4例直接用NBCA胶栓塞 (2例发生术中动脉瘤破裂并发症 ) ,1例用Onyx胶栓塞 ;2 9例畸形团内动脉瘤 2 8例用NBCA胶栓塞 ,1例用Onyx胶栓塞。 2 2例随访或 1～ 3个月后第 2次治疗时造影显示动脉瘤栓塞结果稳定。结论　从本组的经验来看 ,AVM血流相关的Willis环动脉瘤已出血者需先治疗 ,未出血者随访 ;供血动脉动脉瘤需先栓塞治疗后再在该供血动脉内注胶 ;畸形团内动脉瘤是栓塞该AVM时应先考虑栓塞的目标     

经动脉途径低浓度氰基丙烯酸正丁酯栓塞治疗海绵窦硬脑膜动静脉瘘

目的 探讨经动脉途径低浓度(14%～25%)氰基丙烯酸正丁酯(NBCA)栓塞治疗海绵窦硬脑膜动静脉瘘(DCCFs)的可行性.方法 8例DCCFs患者均经动脉入路,使用微导管嵌顿技术注入低浓度NBCA行栓塞治疗.其中5例为经静脉入路栓塞失败者,3例为不可行静脉入路栓塞治疗者.结果 5例患者术后即刻血管造影DCCFs完全消失;随访6～12个月,临床症状完全消失,血管造影未发现DCCFs复发.3例患者术后即刻血管造影DCCFs残留,但血液分流量减少;随访3个月,血管造影血液分流明显减少、临床症状改善2例,血液分流和临床症状均消失1例.1例患者术后出现一过性眼部症状恶化、第Ⅵ脑神经麻痹,经治疗后3 d症状消失.结论 经动脉采用微导管嵌顿技术低浓度NBCA栓塞DCCFs是一种安全有效的方法,对于经静脉入路栓塞失败或不能经静脉入路治疗的患者,可能是一种较为理想的选择.     

氰基丙烯酸正丁酯与栓塞微球治疗大咯血对比研究

目的 对比α-氰基丙烯酸正丁酯(NBCA)胶和三丙烯明胶微球(Embosphere)在支气管动脉栓塞术(BAE)治疗肺部大咯血中的安全性和有效性.方法 收集2010年1月至2014年12月采用BAE术治疗并有完整随访资料的肺部大咯血患者,其中NBCA胶治疗43例(NBCA组),栓塞微球治疗80例(栓塞微球组),对比两组患者BAE技术成功率和临床止血率、并发症发生率、咯血复发率,并对临床结果进行分析.结果 NBCA组和栓塞微球组BAE技术成功率分别为95.3％(41/43)、96.3％ (77/80) (P=0.809);临床止血率分别为93.0％ (40/43) 、92.5％ (73/80)(P=0.639);并发症发生率分别为41.7％(18/43)、35.0％ (28/80)(P=0.452),绝大部分为术后胸痛;咯血复发率分别为16.3％(7/43)、28.8％(23/80)(P＜0.05);两组中各有1例发生脊髓功能障碍,经内科治疗后康复.两组患者Kaplan-Meier生存分析比较结果显示,差异有显著统计学意义(x2=6.523,P=0.041).结论 与栓塞微球相比,NBCA胶治疗肺部大咯血的安全性和有效性相当,但能够降低远期复发率.     

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.     

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.     

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.     

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）     

Die rechtsmedizinische Identifizierung — Bedeutung und Beweiswert —

Zusammenfassung Bei der rechtsmedizinischen Identifizierung kann die Identität im strengen Sinn allenfalls bei lebenden Personen festgestellt werden; sonst läßt sich nur von Teilen auf das Ganze (vom Untersuchungsobjekt auf die Person) schließen, wobei die verschiedenen Merkmale des Untersuchungsobjektes entsprechend der Hdufigkeit ihres Vorkommens eine unterschiedliche Beweiskraft haben. Bei der Schädelidentifizierung mit Hilfe moderner photographischer oder elektronischer Superprojektionsverfahren ergeben sich unter Berücksichtigung der Weichteildicken so viele (fiktive) Vergleichspunkte, daß bei geeignetem Vergleichsmaterial (Photographien) Identität wegen der Vielzahl übereinstimmender Bezugspunkte in den meisten Fällen evident ist.     

Imaging of abdominal nodal spread in malignant disease

This is a review of the role of imaging procedures for the assessment of abdominal and pelvic lymph nodes. The diagnosis of malignant lymphatic spread is rarely the sole purpose of imaging, because it is usually part of a general abdominal examination, most frequently with CT or US, or increasingly with MRI. These studies are often requested in order to obtain information about the situation to be encountered during surgery, or to alert the surgeon to irresectability or to unexpected metastases outside the initially planned area of exploration. In most surgically treated tumours the role of imaging for preoperative staging is limited, due either to its insufficient sensitivity or because the initial treatment is independent of the lymph node stage. Imaging is commonly used to verify treatment response to chemo- or radiotherapy and for follow-up.Correspondence to: S. Delorme