肾动脉成形术治疗肾血管性高血压

评估DSA下的肾动脉成形术对治疗肾血管性高血压的作用。材料和方法：对6例不同病因所致的肾血管性高血压患者在DSA下作了球囊成形术治疗，包括大动脉炎和动脉粥样硬化各二例及纤维肌肉增生、及肾移植后所致的肾动脉狭窄各1例。结果：6例病人作球囊成形术均获得成功，术后血压有较为明显的下降。结论：DSA下的肾动脉成形术对治疗肾血管性高血压是一安全、有效的方法。     

大动脉炎性肾动脉狭窄支架植入术的疗效分析

目的研究经皮腔内血管成形术 内支架植入术治疗大动脉炎性肾动脉狭窄所致肾性高血压的临床效果。资料与方法选用Palmaz支架和AVEBridge支架,对18例大动脉炎所致肾动脉狭窄先行经皮腔内肾动脉成形术(PTRA),然后放置支架。术后检测血管的内径和术后一周时血压的变化。结果18例PTRA 支架植入术技术成功率100%。血管内径由术前平均为(1.7±0.6)mm恢复至术后为(5.3±0.4)mm,术后1周时血压由术前的(22.7±3.3/14.0±2.1)kPa降为(19.3±1.6/10.4±2.0)kPa,其中10例血压恢复正常,6例血压改善。术后随访肾动脉血流通畅,血压控制满意。结论PTRA 支架植入术治疗大动脉炎性肾动脉狭效果满意,创伤小,患者痛苦少;PTRA 支架术是目前治疗大动脉炎性肾动脉狭窄的首选方法,具有安全、简便、有效的优点。     

肾血管性高血压动物模型建立及指标监测

目的　评价单侧肾动脉套管结扎法建立肾血管性高血压的动物模型的效果。方法　将实验狗随机分为正常对照、狭窄对照、肾栓塞和肾切除 4组 ,后 3组行单侧肾动脉套管结扎术建立肾血管性高血压模型。使用颈动脉皮鞘法监测血压。通过对血压、血浆肾素活性、血肌酐和尿素的监测以及肾动脉造影表现对肾血管性高血压动物模型的建立进行分析、比较和讨论。结果　正常对照组及其它各组狗术前正常血压为 (142 .5± 2 .6 ) / (87.6± 2 .5 )mmHg。肾动脉狭窄术后 6d达到稳定的高水平 ,为(195 .6± 14.7) / (135 .6± 10 .5 )mmHg ,肾动脉狭窄术后狗血压显著高于正常 (P <0 .0 1)。造影示肾动脉平均狭窄程度为 80 %。结论　实验中使用单侧肾动脉套管结扎法可成功建立肾血管性高血压动物模型。该动物模型可模拟人类单侧肾动脉狭窄所致的高血压病变 ,重复性强 ,成功率高。     

肾动脉狭窄的介入治疗——附4例报告

肾动脉狭窄所致肾血管性高血压以往依赖药物及外科手术治疗 ,196 4年Ｄｏｔｔｅｒ和Ｊｕｄｋｉｎｇ首先开展了经皮穿刺血管腔内成形术 ,肾动脉狭窄的介入治疗随之应用于临床 ,球囊或血管内支架加压扩张狭窄的肾动脉 ,改善和恢复正常的肾血流灌注而达到治疗目的 ,由于其简便、安全、并发症少 ,介入治疗肾动脉狭窄已成为首选方法之一。1　资料和方法1 1　一般资料　 4例中男 2例 ,女 2例 ,年龄 16— 5 8岁 ,平均 33岁 ,因有不同程度高血压而就诊 ,经内科治疗效果不明显 ,作肾动脉造影证实为肾动脉狭窄 ,血管纤维肉增生症1例、多发性大动脉炎 1…     

儿童肾血管高血压的特殊临床表现及治疗

目的:阐明儿童高血压的特殊临床表现及肾血管性高血压的合理治疗。方法:26例患儿,确诊为肾血管性高血压。其中肾动脉纤维肌发育不良12例,多发性大动脉炎14例。肾动脉支架植入22例,肾动脉球囊成形术2例,患肾切除1例。术后随访3年。结果:介入治疗后血压持续正常21例,继续服用ACEI血压正常5例,支架术后再狭窄2例。肾功能、心功能、血浆肾素水平恢复正常。结论:①运动后发生晕厥、腹痛伴恶心呕吐、原因不明心功能不全的患儿应警惕高血压或高血压危象;②儿童肾血管性高血压的最佳治疗应选择肾动脉介入治疗;③儿童肾动脉支架植入不影响肾脏发育;④肾动脉直径<4mm应先行肾动脉球囊成形术。     

肾动脉狭窄性高血压的DSA表现及临床意义

目的 探讨肾血管性高血压的ＤＳＡ表现及行狭窄段肾动脉扩张术的可行性和必要性。方法 对２１例怀疑肾血管性高血压患者行双侧肾动脉ＤＳＡ检查,并对造影资料进行分析。结果２１例患者中,有１１例肾动脉及其分支狭窄,其中６例行球囊扩张成功,占５４．５５％。结论 肾血管的ＤＳＡ检查是诊断肾血管性高血压首选检查方法,并为介入治疗提供可靠的临床资料。     

经皮肾动脉腔内成形术治疗肾血管性高血压

目的：评价经皮穿刺肾动脉腔内成形术（PTRA）对肾血管性高血压的治疗效果。方法：1983年3月至1996年12月，对21例肾血管性高血压的24支狭窄肾动脉（双侧者3例）施行了PTPA治疗。根据术中狭窄部位动脉压差改变及临床血压变化对其疗效进行了评价。结果：从21例进行了PTRA的24支狭窄肾动脉中，18支（75%）立刻获得技术成功。后经随访的12例病人中，3年疗效；治愈9例（75%），改善2例（16.7%），无效1例（8.3%）；5年疗效：治愈7例（58.3%），改善2例（16.7%），无效3例（25%）。结论：PTRA对肾血管性高血压的治疗是一种简便，安全，且有较好远期疗效的方法。     

动脉粥样硬化性肾动脉狭窄的介入诊断与治疗方法探讨

目的　观察动脉粥样硬化所致的肾动脉狭窄的发生率 ,及经皮肾动脉球囊成形术 (PTRA)加支架术的疗效。方法　对连续 2 0 0例接受冠状动脉 (冠脉 )造影的患者用Judkins右冠脉造影导管作选择性肾动脉造影或腹主动脉数字减影血管造影 (DSA)进行肾动脉造影 ,并对其中 7例肾动脉严重狭窄 (狭窄直径≥ 85 % )患者的 8支狭窄血管行PTRA加支架术 ,所有病变均为动脉粥样硬化所致。结果　 2 0 0例受检者中 ,肾动脉狭窄的发生率为 10 .5 % (2 1例 ) ;其中 ,99例冠状动脉心脏病 (冠心病 )患者肾动脉狭窄的发生率为 19.2 % (19例 )。 8支狭窄肾动脉手术的技术成功率达 10 0 % ,随访 3～ 9个月 ,71.4 %的患者血压易于控制 ,其中 3例复查肾动脉造影未见再狭窄。结论　对冠脉有病变的高血压患者 ,在行冠脉造影的同时 ,有必要加做肾动脉造影 ,有助于肾动脉狭窄的早期诊断和治疗 ,避免发生肾功能衰竭。PTRA加支架术是目前治疗肾动脉狭窄的首选方法 ,具有安全、简便、有效的优点。     

56例大动脉炎肾动脉狭窄的血管造影分析

肾血管性高血压约占全部高血压的5～19%,其中大多数为肾动脉狭窄所致。在我国,大动脉炎是造成肾动脉狭窄的主要原因,其受累的肾动脉的血管造影所见,有其一定特点。本文对56例大动脉炎肾动脉病变的造影资料进行分析,结果如下。     

经皮球囊血管成形术与肾动脉支架术治疗肾动脉狭窄的疗效对比观察

目的观察经皮球囊血管成形术和肾动脉支架植入术治疗肾动脉狭窄的疗效。资料和方法 112例肾动脉狭窄患者随机分为2组:A组,经皮球囊血管成形术组;B组,肾动脉支架术组。比较两组的首次手术成功率、术后6个月并发症发生率、通畅率及术后即刻再狭窄率,术后6个月血压及血肌酐变化情况。结果 B组成功率高于A组(94.64%对76.79%,P<0.01),通畅率B组高于A组(73.21%对30.36%,P<0.01),再狭窄率B组低于A组(10.71%对28.57%,P<0.01),两组并发症发生率差异无统计学意义(P>0.05)。B组高血压治愈率较A组高(P<0.01),肾动脉支架术对动脉粥样硬化所致高血压的改善情况最好,而经皮球囊血管成形术对肌纤维结构不良所致肾血管性高血压的改善情况最好。术后血肌酐B组降低不明显(P>0.05),A组显著降低(P<0.05)。A组术后TGFR、RGFR较术前显著改善(P<0.05),B组术后TGFR较术前显著改善(P<0.05);A组术后TGFR改善更明显,较B组差异有统计学意义(P<0.05)。结论肾动脉支架术操作成功率高、通畅率高、再狭窄率低,对动脉粥样硬化引起的肾动脉狭窄所致高血压改善明显,较经皮球囊血管成形术有较大优势,可作为治疗肾动脉狭窄的一种重要的介入治疗方法。     

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).     

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.     

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）     

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