动脉韧带与左喉返神经的解剖研究

本文用30例成人尸体观察了动脉韧带和左喉返神经,动脉韧带长1.2.97±4.53mm,圆索状动脉韧带23例(77％),直径为3.92±1.12mm。动脉韧带的主动脉端附着于主动脉弓(80％)或降主动脉(20％),肺动脉端附着于左肺动脉,6例肺动脉端位于心包内。19例(63％)左喉返神经绕主动脉弓,11例(37％)绕动脉韧带的主动脉端。     

Blood pressure reduction in pregnancy by sodium chloride.

Volume expansion in the presence of elevated aldosterone availabilityis a hallmark of normal pregnancy. Intravascular volume depletioncharacterizes severe pregnancy-associated disease conditionssuch as intra-uterine growth retardation, chronic hypertensionor pre-eclampsia [1]. Two hypotheses have been forwarded toexplain volume depletion in pregnancy: the first hypothesischarges inappropriate sensing of vascular ‘overfilling’,resulting in an increased transendothelial loss of fluid tothe extravascular compartment. In contrast, the second hypothesisfocuses on vascular ‘underfilling’ due to inappropriatelylow aldosterone levels. The second hypothesis is based on theassumption that a compensatory increase in the circulating fluidvolume is required in normal pregnancy to support fetal substratedelivery. According to the second concept, maternal blood pressureincreases due to counter-regulatory mechanisms when placentalblood supply is reduced [2]. In support of the ‘underfilling’hypothesis are observations that a     

Ankle-brachial index and extent of atherothrombosis in 8891 patients with or at risk of vascular disease: results of the international AGATHA study.

AIMS: AGATHA (a Global Atherothrombosis Assessment) was designed to assess the extent of atherothrombosis and the use of the ankle-brachial index (ABI) in vascular patients. The principal hypotheses were that (1) in diseased patients, a low ABI was related to the number and site of vascular beds affected and (2) in at-risk patients without disease, a low ABI was related to the number of risk factors present. METHODS AND RESULTS: Patients were recruited consecutively by 482 clinicians in 24 countries and the ABI measurement was performed at a single visit. Of 8891 patients recruited, 1792 were defined as at risk and 7099 as with disease. Of the with-disease patients, 65.2% had one arterial bed affected, 27.6% two and 7.1% all three. Abnormal ABI (< or =0.9) was present in 30.9% of at-risk and 40.5% of with-disease patients. A lower ABI was weakly associated with an increasing number of risk factors in at-risk patients (r=-0.056, P=0.02) and with the site and number of arterial beds affected in with-disease patients (P<0.001). CONCLUSION: This large international study confirms that atherothrombotic disease often occurs at more than one site. The ABI is related to the risk factor profile and to the site and extent of atherothrombosis.     

Ketanserin降低清醒自发性高血压大鼠血压波动性的机理初探

应用计算机化清醒大鼠血流动力学测定技术，观察５－ＨＴ２受体阻滞剂Ｒｉｔａｎｓｅｒｉｎ（Ｒｉｔ）和α１受体阻滞剂哌唑嗪对清醒自发性高血压大鼠（ＳＨＲ）的血压、血压波动性（ＢＰＶ）和动脉压力感受性反射血压控制部分（ＡＢＲ－ＢＰ）的效应，旨在初步探讨兼具５－ＨＴ２受体和α１受体阻滞作用地新型抗高血压药Ｋｅｔａｎｓｅｒｉｎ降低ＢＰＶ的机制。结果表明：Ｒｉｔ对ＳＨＲ无降压作用，但侧脑室给药明显提高ＡＢＲ－Ｂ     

全动脉化冠状动脉旁路移植术与常规冠状动脉旁路移植术近期结果比较

目的比较使用桡动脉和乳内动脉全动脉化冠状动脉旁路移植术(CABG)与使用一根乳内动脉和静脉做常规CABG的近期手术结果。方法从1999年1月到2005年1月,阜外心血管病医院共有123例患者(男114例、女9例,年龄52.2±10.1岁)采用全动脉化CABG(全动脉化组),血管移植材料为乳内动脉和桡动脉,目标血管桥在2根以上;同期行常规CABG115例(男102例、女13例,年龄60.3±9.1岁),血管的移植材料为一根乳内动脉和若干静脉桥(常规手术组)。比较两组患者术前、术中和术后的临床结果。结果术前资料比较,全动脉化组的患者年龄更小,常规手术组3支病变患者较多(54.5%vs.86.1%,P=0.001),全动脉化组有更多患者选择非体外循环CABG(26.0%vs.57.4%,P=0.001);在体外循环CABG中,全动脉化组需要更长的手术时间;平均移植血管根数全动脉化组少于常规手术组(2.6±0.7根vs.3.4±0.9根,P=0.001);住院死亡率全动脉化组为0.8%,常规手术组为0.9%,两组比较差异无统计学意义(P=1.000);术后近期并发症发生情况两组结果相似。结论对选择适合的患者采用全动脉化CABG能够提供较为安全的近期手术结果。     

Intra-operative quick insulin assay to confirm complete resection of insulinomas guided by selective arterial calcium injection (SACI)

Background and aims Insulinomas are rare endocrine disorders. Pre-operatively, conventional imaging techniques often fail to localise the tumor. In addition, due to the lack of quick insulin assays, intra-operative confirmation of complete resection was impossible until recently. Materials and methods Six patients with biochemical evidence of an insulinoma underwent pre-operative localisation studies and selective arterial calcium injection (SACI). In addition, insulin was measured before surgery and every 10–15 min after resection of the tumor using a quick insulin assay. Results Pre-operative localisation studies identified the tumor correctly as follows: endosonography: three of four, magnetic resonance imaging: two of four and SACI: six of six. Tumors in the head and body were enucleated while those in the tail were resected (n = 2, each). Those three patients, in whom magnetic resonance imaging and/or endosonography could localise the tumors pre-operatively, underwent laparoscopic surgery while the remaining three patients underwent open surgery. Intra-operatively, insulin dropped to normal levels within 20 min in all cases. After a follow-up of 0.8–3 years, all patients remained biochemically cured. Conclusions Pre-operatively, SACI appears to be a very sensitive localisation technique and may be most helpful in guiding the surgeon if conventional imaging techniques fail to localise the tumor. Complete removal of an insulinoma can be reliably predicted using a quick insulin assay. This paper was presented at the 2nd Biennial Meeting of the European Society of Endocrine Surgeons (ESES), May 18–20, 2006, Krakow, Poland.     

Classification of spatiotemporal hemodynamics from brain perfusion MR images using expectation-maximization estimation with finite mixture of multivariate gaussian distributions.

The ability to cluster different perfusion compartments in the brain is critical for analyzing brain perfusion. This study presents a method based on a mixture of multivariate Gaussians (MoMG) and the expectation-maximization (EM) algorithm to dissect various perfusion compartments from dynamic susceptibility contrast (DSC) MR images so that each compartment comprises pixels of similar signal-time curves. This EM-based method provides an objective way to 1) delineate an area to serve as the in-plane arterial input function (AIF) of the feeding artery for adjacent tissues to better quantify the relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), and mean transit time (MTT); 2) demarcate regions with abnormal perfusion derangement to facilitate diagnosis; and 3) obtain parametric maps with supplementary information, such as temporal scenarios and recirculation of contrast agent. Results from normal subjects show that perfusion cascade manifests (in order of appearance) the arteries, gray matter (GM), white matter (WM), veins and sinuses, and choroid plexus mixed with cerebrospinal fluid (CSF). The averaged rCBV, rCBF, and MTT ratios between GM and WM are in good agreement with those in the literature. Results from a patient with cerebral arteriovenous malformation (CAVM) showed distinct spatiotemporal characteristics between perfusion patterns, which allowed differentiation between pathological and nonpathological areas.     

异搏定区域动脉灌注在阻止急性胰腺炎重症化治疗中的作用

目的探讨钙拮抗剂异搏定区域动脉灌注在阻止急性胰腺炎重症化治疗中的作用。方法45例轻型急性胰腺炎患者被随机分为3组常规治疗组、静脉治疗组及动脉灌注组。入院后,常规治疗组采取常规保守治疗;静脉治疗组行合理液体治疗,静脉注射异搏定;动脉灌注组液体补充同时采用持续动脉灌注异搏定1~2周。测定治疗后1、4及7d血清肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、黏附分子-1(ICAM-1)及P-选择素(P-selectin)水平。结果治疗后4、7d,血清TNF-α和P-selectin水平动脉灌注组较静脉治疗组及常规治疗组明显降低(P<0.05);血清IL-1β水平动脉灌注组和静脉治疗组均较常规治疗组明显降低(P<0.05);血清ICAM-1水平动脉灌注组明显低于常规治疗组(P<0.05)。结论持续区域动脉灌注异搏定可能通过减少细胞因子的产生,抑制黏附分子P-selectin和ICAM-1的上调,阻止急性胰腺炎重症化发展。     

内镜联合肝动脉栓塞化疗、射频消融治疗肝细胞癌合并胆管癌栓

目的探讨内镜联合肝动脉栓塞化疗（transcatheter arterial chemoembolization，TACE）、射频消融（percutaneous radiofrequency ablation，PRAF）治疗肝细胞癌（hepatocellular carcinoma，HCC）合并胆管癌栓的治疗效果。方法回顾总结1999年1月～2005年12月收治的65例肝细胞癌合并胆管癌栓的诊疗情况。结果65例中，均行内镜胆道引流术或EST及取栓，联合TACE，PRAF治疗。本组无手术死亡。癌栓清除率为95．4％（62／65），肿瘤坏死率为96．9％（63／65），1年生存率为60．0％（39／65），3年生存率为38．5％（25／65）。结论内镜联合TACE及PRAF治疗肝细胞癌合并胆管癌栓不失为一种行之有效的微创治疗方法，疗效优于单纯的内镜、TACE及PRAF治疗。     

经肝动脉灌注三氧化二砷对肝移植瘤血管的作用

目的 :探讨经肝动脉灌注As2 O3 对肝移植瘤血管的作用 .方法 :采用新西兰大白兔建立 5 0只肝脏Vx 2移植瘤动物模型 ,随机平均分成 5组 .移植瘤术后 2wk ,经肝动脉插管灌注不同浓度As2 O3 ,并以顺铂和生理盐水作对照 ,连续 7d ,6wk末切取肝肿瘤组织 ,观察肿瘤组织微血管有无改变 ,检测移植瘤组织血管内皮生长因子 (VEGF)的表达 .结果 :实验组肿瘤组织毛细血管内皮细胞肿胀、细胞核碎裂、细胞坏死及微血栓形成 ,阴性对照组和阳性对照组无类似改变 .实验组VEGF表达低于对照组 ,差异有显著性 (P <0 .0 1 ) ,而实验组间VEGF表达无差异性 (P =1 .0 0 ) .结论 :经肝动脉灌注As2 O3可减少肿瘤组织的血管生成 ;选择性破坏肝移植瘤组织血管 ,并存在一定剂量效应相关性