Portal vein stenosis after liver transplantation: treatment with percutaneous transhepatic angioplasty

We used transhepatic percutaneous transluminal angioplasty to treat two patients who developed a severe anastomic portal vein stricture 7 months and 4 years respectively after liver transplantation. All signs of portal hypertension (pressure gradient, massive venous collateral circulation) disappeared following the procedure and remained absent 12 months later. Our results suggest that percutaneous transhepatic angioplasty should be considered for treatment of liver transplant recipients with anastomotic portal vein strictures. Correspondence to: P. Legmann     

In vitro absorption of some chlorinated paraffins through human skin

The in vitro absorption of chlorinated paraffins, Cereclor S52 and Cereclor 56L (present in a cutting fluid), has been measured through human skin. During 56 h continuous skin contact no Cereclor S52 was detected to have been absorbed and only a very slow rate of Cereclor 56L absorption (mean rate, 0.04 g/cm/h) was measured. This rate was only apparent after more than 7 h continuous skin contact. These chlorinated paraffins were very poorly absorbed through human skin and human dermal exposure should not cause significant systemic levels.     

Microcirculation in the upper trapezius muscle during varying levels of static contraction,fatigue and recovery in healthy women —a study using percutaneous laser-Doppler flowmetry and surface electromyography

Summary Microcirculation in the upper portion of the trapezius muscle was measured percutaneously by continuous laser-Doppler flowmetry (LDF) during two 10-min series of alternating 1-min periods of static contraction and rest determined electromyographically (EMG). Stepwise increased contraction was induced by keeping the arms straight and elevated at 30, 60, 90 and 135°, which was repeated with a 1-kg load carried in each hand. Thereafter, fatigue and recovery were recorded while the subject kept her arms straight and elevated at 45° carrying the 1-kg hand load as long as possible, followed by rest with arms hanging and no load. A group of 16 healthy women of different ages was studied. Signal processing was done on line using a 386 SX computer. The LDF- and root-mean-square (rms) EMG signals were normalized. Spectrum analyses of EMG mean power frequency (MPF) and median spectrum frequency were performed. The rms-EMG increased significantly with an increase in the calculated shoulder torque (r=0.75). Accumulated local fatigue was indicated by a decrease in MPF with increased shoulder angle and added load (r = –0.54). Blood flow increased with increased shoulder angle (r=0.82, with hand loadr=0.62) and with increased shoulder torque (r=0.72), and also showed a significant increase with increased EMG activity (r=0.74). The LDF showed a negative correlation to MPF (r= –0.67), with increased values when MPF was lowered. During the endurance test, a moderate increase of LDF occurred which reached its maximum during the 1st min of recovery. Then, a slow return to the base level was recorded. The ability to increase the flow in the microcirculation with increasing muscle load was not diminished with age.     

经皮锁定加压钢板固定胫骨多段骨折21例疗效分析

目的探讨经皮锁定加压钢板(locking compression plate,LCP)手术治疗胫骨多段骨折的临床疗效。方法将2010年6月~2011年12月收治的胫骨多段骨折患者,根据AO分类方法筛选出C2型骨折21例:左侧9例,右侧12例;男性14例,女性7例;年龄15~71岁,平均(44±2.1)岁。入选病例均采用微创经皮插入LCP钢板手术内固定治疗。结果随访8~15个月,术后3~4月骨折线变模糊,术后6~9月骨折处出现大量骨痂;膝关节屈曲为(147±3.2)°,伸直为(0±0.5)°;踝关节背伸(9±1.2)°,跖屈(43±2.1)°;Johner-Wruhs评分标准:优17例,良3例,可1例,差0例;优良率95.24%。结论经皮LCP钢板固定胫骨多段骨折安全、有效,是值得推广的手术方式。     

经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折

目的初步探讨应用球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折的临床疗效。方法应用球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折患者24例28个椎体，并随访4～11个月，平均8个月。结果所有患者手术均获成功，无脊髓神经损伤，病椎疼痛缓解，后凸畸形平均矫正20°，随访期间，疗效满意，无病椎高度丢失。结论应用经皮椎体成形术治疗骨质疏松性椎体压缩骨折能明显改善患者疼痛症状，恢复椎体高度，矫正后凸畸形，是一种安全的微创方法。     

经皮穿刺椎间盘髓核摘除术入路的研究

为提供椎间盘髓核摘除术形态学依据，在7具成人横断面标本上观察测量了L1～L5椎间盘平面经皮穿刺椎间盘髓核摘除术的进针点、角度和深度。发现在L1～L3、L4～L5椎间盘髓核的穿刺点以距后正中线8～10cm，9～11cm，穿刺角度以46．7°～59．5°，穿刺深度为110．2～128．9mm为最宜。     

G蛋白β3亚单位基因C825T多态性与PTCA支架内再狭窄

目的 探讨G蛋白β3亚单位基因C825T多态性与PTCA支架植入后再狭窄之间的相关性。方法 采用多聚酶联反应结合限制性内切酶片断长度多态性分析方法(PCR-RFLP)检测50例经PTCA支架植入术后半年内发生再狭窄的患者和85例经PTCA支架植入在半年内未发生再狭窄的患者之间G蛋白β3亚单位基因C825T多态性。结果 再狭窄组G蛋白β3亚单位基因型频率(CC 14％、CT 54％、TT 32％),等位基因频率(C 41％、T 59％)与未狭窄组G蛋白β3亚单位基因型频率(CC31.8％、CT 44.7％、TT 23.5％),等位基因频率(C 54.2％、T 45.8％)比较统计学上有差异。结论 G蛋白β3亚单位基因C825T多态性可能与PTCA支架内再狭窄有关。     

冠脉内支架临床发展策略

冠脉内支架是临床上预防ＰＴＣＡ并发症的有效措施，但金属支架固有的血栓菜成原性和对血管壁组织的永久性刺激可导致院内心脏事件和再狭窄。为解决上述问题，作者提出，血管内支架联合靶向药物传输离子照射或基因治疗、基因修饰的内皮细胞的种植支架、吱物可吸收缓释药物支架材料研制为临床冠脉内支架开辟了广阔的发展前景。     

川芎嗪对急性心肌梗死血运重建后"心肌无复流"患者心肌组织灌注的影响

目的 观察川芎嗪对急性心肌梗死（AMI）患者梗死相关血管（mA）再通后心肌无复流（No．reflow，NR）现象的疗效。方法 首次急性sr段抬高心肌梗死（STEMI）患者，急诊经皮经腔冠状动脉介入（PCI）后，经单光子发射型计算机断层显像（SPECT）诊断为心肌NR者，随机分为治疗组（40例）和对照组（42例）。对照组接受常规治疗，治疗组在常规治疗基础上静脉给予川芎嗪注射液。分别于24h内（4—24h）及15d后（15—28d）复查SPECT，观察左室心肌灌注缺损积分（myocardium peffusion defect score，MPDS），左室射血分数（LVEF）、左室舒张末期容积（LVEDV）和左室收缩末期容积（LVESV）。结果 24h内及15d后，治疗组的MPDS均较PCI后即刻减低，其减低幅度均显著大于对照组（均P〈0．05）；两组的LVESV和LVEDV均呈增加趋势，但治疗组LVESV和LVEDV的增加幅度显著低于对照组（均P〈0．05）；15d后治疗组SPECT心肌NR的发生率显著低于对照组。结论 川芎嗪可显著改善心肌组织灌注，减轻心肌NR现象，从而缩小心肌坏死范围。抑制心室重构。