脑动静脉畸形的X刀治疗

目的　探讨立体定向放射外科治疗脑动静脉畸形的临床效果。方法　对 87例脑动静脉畸形患者采用X刀治疗 ,畸形团大小大小 5～ 4 0mm。单独接受X刀治疗 5 5例 ,联合血管内栓塞治疗32例。治疗周边剂量 17～ 30Gy ,平均 2 2 .6Gy ,等剂量曲线 70 %～ 90 %。随访时间 6～ 96个月 ,平均 5 3.4个月。结果　单独应用X刀治疗的脑动静脉畸形患者 ,完全闭塞 4 1例 ,部分闭塞 9例 ,无变化 5例 ;联合血管内栓塞治疗患者 ,完全闭塞 2 6例 ,部分闭塞 3例 ,无变化 3例。全组完全闭塞 6 7例 (77.0 % )。癫痫完全缓解 7例 (2 6 .2 % ) ,头痛头昏症状缓解 18例 (38.3% )。并发症 :再出血 2例 ,症状性放射性脑水肿 6例 ,经治疗后 ,完全缓解 2例 ,遗留神经功能障碍 4例。结论　立体定向放射外科是脑动静脉畸形的安全而有效的治疗方法之一。     

脑转移瘤γ刀、X刀治疗后MRI观察与分析

目的　利用MRI评价立体定向放射外科治疗脑转移瘤的疗效。方法　选择 70例经γ刀、X刀治疗后的MRI复查资料进行分析治疗后的影像表现。结果　经γ刀、X刀治疗后肿瘤控制率在 91%,消失率在 5 8%,肿瘤消失缩小 ,肿瘤强化程度减低 ,病灶中间出现坏死 ,环状强化是疗效满意的征像。肿瘤增大 ,水肿增大 ,先小后大 ,出现新病灶是复发的征像。结论　脑转移瘤立体定向放射外科治疗后应用MRI能客观评价治疗效果     

松果体生殖细胞瘤放射治疗分析

目的　探讨立体定向放射治疗技术联合常规放疗在松果体生殖细胞瘤治疗中的应用及治疗效果。方法　 1996年4月— 1997年 9月 7例松果体生殖细胞瘤患者接受放射治疗 ,其中 2例应用γ 刀立体定向单次大剂量放射治疗加全脑全脊髓放射治疗 ,3例应用X 刀立体定向分次放射治疗加全脑全脊髓放射治疗 ,2例应用常规放疗加全脑全脊髓放射治疗。结果　 5例患者行γ 刀、X 刀立体定向放射治疗联合全脑全脊髓放射治疗 ,治疗结束后 4例患者肿瘤消失 ,1例肿瘤明显缩小 ;2例行常规放疗联合全脑全脊髓放射治疗者 ,治疗结束后肿瘤均明显缩小 ;所有患者在治疗过程中均有轻度恶心呕吐 ,白细胞下降 ,治疗结束后临床症状均明显减轻。 1例患者因严重消化道反应及白细胞下降终止治疗 ,于 5个月后出现脊髓转移。 2例随访 2 6个月 ,1例随访 18个月 ,2例随访 12个月 ,均无肿瘤复发。结论　应用立体定向放射治疗技术联合常规放疗能有效控制肿瘤 ,不良反应小 ,安全可靠 ,可能成为松果体生殖细胞瘤首选治疗方法。     

百令胶囊加胸腺肽治疗中晚期肿瘤临床疗效分析

目前肿瘤的药物治疗主要是化疗 ,由于化疗的副作用较大 ,使许多患者难以接受治疗或难以完成整个疗程而达不到治疗效果 ,我院从 2 0 0 2年 2月至2 0 0 3年 7月用百令胶囊加胸腺肽治疗肿瘤 4例 ,收到良好效果 ,现报道如下。1　临床资料　　病例介绍　病例 1,男性 ,70岁 ,诊断精原细胞瘤 ,于 2 0 0 2年 4月 2 2日入院。查 :右颈部淋巴结肿大 ,大小约 5 .0cm× 4 .0cm× 2 .0cm ;左颈部淋巴结肿大 ,大小约 2 .5cm× 1.5cm× 1.0cm ;两腋下淋巴结肿大 ;中腹部可触到大小约 3.5cm× 3.5cm× 3.0cm包块。患者声音嘶哑 ,吞咽困难。给予化疗治疗 ,疗…     

CT对脑转移瘤不同放射治疗方法的疗效评估

目的分析单纯X线立体定向放射治疗(SRT)及附加全脑照射方法治疗脑转移瘤的疗效.方法将41例脑转移瘤共78个病灶分两组,24例行单纯SRT,17例在术后附加全脑放疗;按病灶大小将本组78个病灶分为大病灶(＞3cm)和小病灶(＜3cm)两组.全部病例于术后2～19个月进行了CT随访.结果单纯SRT组肿瘤治疗有效率92.9%,SRT附加全脑放疗组为93.7%,大病灶组有效率90%,小病灶组有效率97.4%(Ρ＞0.05).单纯SRT肿瘤复发率为25%,而附加全脑放疗为5.9%(Ρ＜0.05).19.5%术后出现放射性脑水肿.结论SRT是脑转移瘤的一种有效的治疗手段,SRT附加全脑放疗能明显控制肿瘤的复发率,对于小于3cm的转移瘤尤为适应.     

X射线立体定向放射治疗后脑肿瘤的病理学观察

X射线立体定向放射用于治疗脑肿瘤已多年 ,对治疗后肿瘤的病理变化报道甚少 ,且多为动物实验[1～2 ]。我们收集经X射线立体定向放射治疗后又行手术切除的脑肿瘤标本 ,观察这些肿瘤的病理学改变。一、材料和方法1 材料 :洛阳医学高等专科学校附属医院经立体定向放射治疗后又手术切除的脑肿瘤标本 2 4例。经常规石蜡制片 ,HE染色。美国产Varian 60 0c直线加速器和德国Fisher公司ZD立体定向手术系统 ,准直器直径 10～ 2 3mm ,以等中心剂量的 80 %等剂量曲线覆盖肿瘤边缘 ,并以此剂量为靶区处方剂量 ,总剂量 16～ 3 6Gy ,分次剂量 :8～ 12Gy…     

脑转移瘤放射外科学的作用

美国威斯康星大学医学院前瞻性研究立体放射外科(SR)对脑转移瘤的作用。1988年12月～1991年3月共收治40例病人,KPS均大于50%,共58处转移灶,其中30例为单发,6例为放射敏感肿瘤(1例小细胞肺癌,5例淋巴瘤),12例位于幕下,其余为幕上。15例为外照射后复发病例(平均时间12个月),25例为作为全脑外照射的追加剂量进行SR治疗的,其外照射剂量平均为30Gy/10次。设备包括加速器、固定系统、三维显象系统、剂量监测、靶定位、治疗计划、质控系统等。4例用两个等中心照射,其余皆为一个等中心,准直器大小为1.0～4.0cm,平均2.5cm,肿瘤直径0.25～0.5cm,包括在80%等剂量曲线内,平均剂量25Gy。平均随访时间为6.5个月,其中14例随访9个月以上。     

射波刀治疗>3 cm脑转移瘤的疗效及安全性

目的 回顾性分析射波刀治疗>3 cm脑转移瘤（每例患者脑转移灶≤3个）的临床疗效及安全性。方法 选取中国人民解放军总医院第六医学中心47例经病理诊断的恶性肿瘤脑转移患者,其中43例单发,2例为3个病灶,另2例为2个病灶,且每名患者至少有1个病灶直径>3 cm,仅给予射波刀治疗,8～12 Gy/次,共计3～5次,治疗后1周、1个月评估疗效及不良反应,此后根据原发肿瘤情况,平均每2～3个月评估1次。结果 治疗后1周、1个月生存质量改善率分别为9%、72%,治疗后3个月评价治疗总有效率为83%,疾病控制率为96%,6个月及1年总生存率分别为95.7%和93.6%,期间急性脑水肿发生1例,激素依赖性脑水肿发生1例,无3级以上不良反应。结论 射波刀治疗>3 cm脑转移瘤是一种安全有效的治疗手段。     

伽玛刀治疗晚期胰腺癌的临床研究

目的　探讨立体定向放射治疗晚期胰腺癌的近期临床疗效。方法　采用QUR QGD型立体定向伽玛射线体部治疗系统 (体部伽玛刀 )治疗 16例晚期胰腺癌患者。本组病例伽玛刀治疗等剂量曲线为 5 5 %～ 70 % ;肿瘤≤ 5cm的单次周边剂量 4 0～ 5 5Gy ,肿瘤 >5cm的单次周边剂量 3 0～ 4 0Gy ;治疗总剂量为32～ 4 8Gy ;治疗次数 8～ 11次 ,大多数患者为隔日治疗。结果　伽玛刀治疗过程中部分患者上腹部及腰背部疼痛明显减轻 ,2位患者黄疸消退。伽玛刀治疗 3个月第一次复查 ,病变部位达到完全缓解 3例 ,部分缓解 13例 ;总有效率 (完全缓解 +部分缓解 ) 10 0 %。 6个月复查 ,病变部位达到完全缓解 5例 ,部分缓解 9例 ,无变化2例 ;总的症状、体征缓解率为 81 2 5 % (13/16 )。未见穿孔、大出血、持续高热等严重并发症发生。结论　体部伽玛刀治疗晚期胰腺癌能使肿瘤局部得到准确的高剂量照射 ,周围正常组织损伤小 ,近期疗效理想 ,为临床肿瘤医生提供了一个新的治疗手段。     

T_1期声门癌放疗时照射野与杓状软骨水肿

放疗是治疗声门癌首选方法之一,据报道对T期声门癌的局部控制率为80%～90%。但放疗后引起的永久性喉水肿发生率约占6%～23%。作者报道了1982年5月至1986年12月间,行根治性放疗的T_1期声门癌116例。全部病人均取仰卧位,头尽力后仰至喉全部暴露。用4MVX线,STD(源瘤距)80cm,双侧平行对穿照射及楔形滤过技术。把病人随机分为5cm×5cm和6cm×6cm两种照射野。116例中有111例(96%)的照射剂量为60Gy/30次/6周;2例因早期粘膜炎只给52～56Gy;另3例给64～68Gy。通常总剂量给60Gy预期要发生晚期喉水     

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 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).     

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.