Image technique optimization in MR imaging of a titanium alloy joint prosthesis

The purpose of this study was to explore systematically the effect of the imaging parameters changeable by the user in spin-echo (SE) imaging sequences to minimize image distortion when imaging joint prostheses. A titanium alloy hip joint prosthesis was studied at 1.0 T. The SE imaging parameters were bandwidth/pixel (BW/p), TE, strength of encoding gradients (matrix size), echo train length (ETL), and direction of phase and frequency encoding. The effect of ETL in rapid acquisition relaxation enhanced (RARE) sequences was also evaluated with a turbo-SE sequence using a different ETL with the same TR and an effective TE. It is concluded that an optimized image quality can be achieved in SE imaging by using a high bandwidth/pixel value (at least 130 Hz/pixel), a high resolution matrix (256–512), sequences with multiple refocusing, and a frequency-encoding axis parallel to the long axis of the prosthesis. The degree of distortion is reduced with this optimized technique.     

风心病并发脑栓塞病人的瓣膜替换术

报告６４例风心病并发脑栓塞病人的瓣膜替换术。术前心功能Ｉ级１０例、ＩＩ级３８例、ＩＶ级１６例。伴房颤者５４例。脑栓塞史半年以上者４４例，６个月以内２０例，其中２个月以内者１４例。３４例有程度不同的脑栓塞后遗症。行二尖瓣替换术４７例、双瓣膜替换术１７例，同期行三尖瓣环环缩或成形术４３例。术中证实有左房血栓２５例（３９％）。手术死亡率６．２５％。术后并发颅内出血和栓塞各１例。结果表明风心病并发脑栓塞病人的手术效果良好。作者指出，脑栓塞２个月以上者应尽早手术，２个月以内者则应根据脑栓塞程度、恢复情况及有无左房血栓，选择手术时机。并介绍了围术期的处理经验。     

对500名广州妇女关于激素替代疗法态度的调查

【目的】了解广州妇女对激素替代疗法 (HRT)的态度。【方法】对 5 0 0名妇女进行面对面的问卷调查 ,记录她们对绝经症状以及激素替代疗法的认识和态度。【结果】 5 9%的妇女认为对绝经症状应该求医 ,41%妇女采取消极忍耐的态度 ,76 2 %的人选择妇科就诊 ,19 8%的妇女选择内外科或精神科 ;仅有 2 2 1%的妇女听说过HRT。绝经后妇女应用HRT的有5 9% ,2 4 4%的人不知道HRT的益处 ,知道可以预防骨质疏松和心血管疾病的分别有 17 8%和 10 8% ,5 9 8%的人不知道HRT的副作用 ,13 6 %的人不知道在哪科医生的指导下应用HRT ,40 4%的人不知道何时开始应用HRT。【结论】我们认为广州妇女的围绝经期保健意识不强 ,对HRT的了解很少 ,对HRT的利弊认识不足 ,有必要开展这方面的科普教育工作。     

心脏机械膜瓣置换术后血浆蛋白C和蛋白S活性变化及其与INR的关系

目的:探讨机械瓣膜置换术后口服华法令抗凝的患者血浆蛋白C(PC)、蛋白S(PS)活性改变的意义及其与国际标准IL比值(INR)的关系。方法:动态监测15例心脏机械瓣膜置换术后口服抗凝药初期患者服药1-2 d、3~10 d及1个月的PC、PS活性及INR值。结果:患者组PC、PS活性低于正常对照组(P<0.05),特别是术后3-10 d PC、PS活性明显低于正常对照组(P<0.01),已下降到正常的50％左右,而此时INR尚未达到治疗范围,提示口服抗凝药治疗初期在人体凝血功能未下调时,抗凝系统功能已经开始下降,有发生血栓的倾向;并且,随着抗凝强度的增高(INR低于1.5-高于2.5),PC、PS活性明显下降。结论:口服华法令抗凝患者在监测INR的同时,需要进行血浆PC、PS活性监测,以更好地预防血栓的发生。     

Reoperation for a patient with starr-edwards aortic valve malfunction due to pannus formation twenty-nine years after implantation

We report a re-do case of severe aortic valve stenosis due to pannus formation 29 years after an aortic Starr-Edwards caged-ball valve implantation. A huge shelf of calcified and thick pannus tissue below the valve had reduced the already small orifice by at least a third in surface area. The explanted Starr-Edwards valve revealed no mechanical or structural failure. Early detection and treatment of pannus outgrowth is essential in order to prevent life-threatening prosthetic valve malfunctions.     

Nephrology and renal replacement therapy in Romania--transition still continues (Cinderella story revisited).

INTRODUCTION. This report describes the current status of nephrology and renal replacement therapy (RRT) in Romania, a country with previously limited facilities, highlighting national changes in the European context. METHODS: Trends in RRT development were analysed in 2003, on a national basis, using the same questionnaires as in previous surveys (1991, 1995). Survival data and prognostic risk factors were calculated retrospectively from a large representative sample of 2284 patients starting RRT between January 1, 1995 and December 31, 2001 (44% of the total RRT population investigated). RESULTS: In 2003, RRT incidence [128 per million population (p.m.p.)] and prevalence (250 p.m.p.) were six and five times higher, respectively, than in 1995. The annual rate of increase in the stock of RRT patients (11%) was supported mainly by an exponential development of the continuous ambulatory peritoneal dialysis (CAPD) population (+600%), while the haemodialysis (HD) growth rate was stable (+33%) and renal transplantation made a marginal contribution. Renal care infrastructure followed the same trend: nephrology departments (+100%) and nephrologists (+205%). The characteristics of RRT incident patients changed accordingly to current European epidemiology (increasing age and prevalence of diabetes and nephroangiosclerosis). The estimated overall survival of RRT patients in Romania was 90.6% at 1 year [confidence interval (CI) 89.4-91.8] and 62.2% at 5 years (CI 59.4-65.0). Patients' survival was negatively influenced (Cox regression analysis) by age >65 years (P < 0.001), lack of pre-dialysis monitoring by a nephrologist [P = 0.01, hazards ratio (HR) = 0.8], severe anaemia, lack of erythropoetin treatment (P < 0.001, HR = 0.6), and co-morbidity, e.g. cardiovascular diseases (P < 0.001, HR = 1.8) and diabetes mellitus (P < 0.001, HR = 2.2). CONCLUSIONS: Although the rate of increase in RRT patient stock in 1996-2003 in Romania was the highest in Europe, the prevalence remained below the European mean. As CAPD had the greatest expansion, followed by HD, an effective transplantation programme must be set up to overcome the imbalance. The quality of RRT appears to be good and survival was similar to that in other registries. Further evolution implies strategies of prevention, based on national surveys, supported by the Romanian Renal Registry.     

Extended trans-septal approach for mitral valve surgery: Our early experience

Background Extended trans septal (ETS) approach for mitral valve surgery often divides the artery to the Sino-Atrial node. The clinical implication of this is contentious. We analyzed our early results with ETS approach. Methods Between June 1998 and September 2003 eleven patients underwent mitral valve surgery by ETS approach. Six were females. Age ranged from 19 years to 67 years (median 40 years). Six underwent mitral valve replacement (MVR). Four underwent aortic and mitral (double) valve replacement (DVR). One had mitral valve repair. Three had additional procedures (tricuspid valve repair=1, Coronary artery bypass=1, Aorto bifemoral graft=1). Cardiopulmonary bypass ranged from 64 minutes to 77 minutes (median 72 minutes) for MVR and 112 minutes to 178 minutes (median 140 minutes) for DVR. Aortic cross clamp times ranged from 39 minutes to 52 minutes (median 47 minutes) for MVR and 74 minutes to 120 minutes (median 95 minutes) for DVR. Results There was no mortality or morbidity attributed to the ETS approach. One early death in emergency DVR was due to heart failure. Three patients needed seqeuntial pacing in the immediate post-operative period. Nine out of ten survivors were back to their preoperative rhythms on hospital discharge (6 sinus rhythm; 3 atrial fibrillation). One patient with preoperative trifascicular block who underwent reoperation to fix a paravalvular mitral leak needed a permanent pacemaker (VVI). The follow-up ranged from 1 month to 64 months (median 6 months) and is 100% complete. There was no late death or new arrhythmia. Conclusions Extended trans septal approach is safe. It gives excellent exposure of the mitral valve. division of the sinus node artery is not deleterious in the short to intermediate term. Presented at the 50th Annual Meeting of IACTS. New Delhi, Feb. 2004.     

磨损微粒诱导的局部生物学反应

人工髋关节置换失败的主要原因是假体的无菌性松动。研究表明 ,这和假体长期磨损产生的微粒作用于周围的巨噬细胞而诱发的生物学反应有关。磨损微粒激活假体周围组织细胞释放前炎症介质 ,诱导破骨细胞的活化和分化 ,引发假体周围的骨溶解。充分地认识这个过程 ,对减少人工关节无菌性松动 ,延长假体使用寿命具有重要意义。     

舒芬太尼对心脏瓣膜置换术患者麻醉诱导期血液动力学的影响

目的观察舒芬太尼对心脏瓣膜置换术患者麻醉诱导期血液动力学的影响。方法心脏瓣膜置换手术患者20例,随机分为舒芬太尼组(S组,n=10)和芬太尼组(F组,n=10)。全麻诱导:咪唑安定0.1～0.3mg/kg,维库溴铵0.1～0.2mg/kg。S组使用舒芬太尼1μg/kg,F组使用芬太尼10μg/kg。血液动力学监测:心电Ⅱ导联示波,有创动静脉测压,放置6腔Swan-Ganz导管,采用美国Baxter-2型连续心排血量多功能监测仪,测定心脏指数(CI)和肺毛细血管嵌压(PCWP)。观察心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心脏指数(CI)和肺毛细血管嵌压(PCWP)。分别于麻醉诱导前(T1)、麻醉诱导后气管插管前(T2)、插管后1分钟(T3)、5分钟(T4)和10分钟(T5)记录观察指标。结果HR、MAP、CVP和PCWP两组变化趋势基本一致。麻醉诱导后及气管插管后部分时间S组HR和MAP低于F组(P<0.05或P<0.01),插管后S组CVP明显高于F组(P<0.05或P<0.01)。麻醉诱导或气管插管后,F组CI明显下降(P<0.05或P<0.01),S组均无明显变化。观察期间PCWP均无明显变化。结论舒芬太尼可安全的用于心脏瓣膜置换手术。