应用白芨建立门静脉高压动物模型

目的寻求制作门静脉高压动物模型的最佳方法，并以此为基础从事肝硬化后门静脉血液动力学基础研究。方法以3组共15只兔为动物模型，分别以0.2％、0．4％、0.8％浓度的白芨粉为栓塞材料，开腹注入兔门静脉内，手术前后行门静脉测压、血管造影及病理学检查，最长观察时间阎周.结果以0．4％浓度白芨粉制作门静脉高压模型最佳，4周后肝脏体积缩小20％，门静脉压平均升高40％，病理呈典型坏死后肝硬化表现。结论以白芨粉为栓塞材料制作肝硬化门静脉高压动物模型方法简单、效果可靠已重复性好.以不同浓度的白芨栓塞剂来控制坏死后肝纤维化的程度是本试验的一大特点,本动物模型的建立对深入研究肝硬化门静脉高压的成因及治疗措施有着重要意义。     

Gunther Tulip Inferior Vena Cava Filter Placement During Treatment for Deep Venous Thrombosis of the Lower Extremity

Purpose To evaluate the efficacy and safety of Gunther tulip retrievable vena cava filter (GTF) implantation to prevent pulmonary embolism during intravenously administered thrombolytic and anticoagulation therapy and interventional radiological therapy for occlusive or nonocclusive deep venous thrombosis (DVT) of the lower extremity.Methods We evaluated placement of 55 GTFs in 42 patients with lower extremity DVT who had undergone various treatments including those utilizing techniques of interventional radiology.Results Worsening of pulmonary embolism in patients with existing pulmonary embolism or in those without pulmonary embolism at the time of GTF insertion was avoided in all patients. All attempts at implantation of the GTF were safely accomplished. Perforation and migration experienced by one patient was the only complication. Mean period of treatment for DVT under protection from pulmonary embolism by the GTF was 12.7 ± 8.3 days (mean ± SD, range 4–37 days). We attempted retrieval of GTFs in 18 patients in whom the venous thrombus had disappeared after therapy, and retrieval in one of these 18 cases failed. GTFs were left in the vena cava in 24 patients for permanent use when the DVT was refractory to treatment.Conclusion The ability of the GTF to protect against pulmonary embolism during treatment of DVT was demonstrated. Safety in both placement and retrieval was clarified. Because replacement with a permanent filter was not required, use of the GTF was convenient when further protection from complicated pulmonary embolism was necessary.     

肝癌门静脉癌栓的经皮激光消融治疗

目的 介绍肝癌门静脉癌栓激光消融治疗的方法,并探讨这一治疗方法的安全性和疗效。方法 对24例肝癌门静脉癌栓患者30支门静脉癌栓进行经皮肝穿刺激光消融治疗,观察术后患者癌栓支门静脉多普勒彩色血流图谱的变化及临床症状、肝功能和腹水等的变化情况。结果 术前30支门静脉癌栓支均无血流信号,术后1d有28支门静脉再次观察到彩色血流信号;术后7d30支门静脉癌栓支均观察到了多普勒彩色血流信号;术后30d有12支可观察到连续但不稳定的彩色血流信号,16支可观察到连续且稳定的再通血流信号;术后90d有18支可观察到连续且稳定的再通血流信号。临床症状、肝功能和腹水均得到了不同程度的改善。结论 肝癌门静脉癌栓的激光消融治疗有望成为一种疗效可靠、技术安全的门静脉癌栓治疗新方法。     

Fibrocartilaginous embolism--an uncommon cause of spinal cord infarction: a case report and review of the literature

Fibrocartilaginous embolism is a rare cause of spinal cord infarction. It is postulated that an acute vertical disk herniation of the nucleus pulposus material can lead to spinal cord infarction by a retrograde embolization to the central artery. An increased intradiskal pressure resulting from axial loading of the vertebral column with a concomitant Valsalva maneuver is thought to be the initiating event for the embolus. We present a previously healthy 16-year-old boy with sudden onset of back pain and progressive paraparesis within 36 hours after lifting exercises in a squat position. His clinical presentation and neuroimaging studies were consistent with spinal cord infarction resulting from a central artery embolus at the T8 spinal cord level. Laboratory investigation showed no evidence of infectious, autoimmune, inflammatory, or neoplastic causes. Although no histologic confirmation was obtained, lack of evidence for other plausible diagnoses in the setting of his clinical presentation and in the magnetic resonance imaging findings made fibrocartilaginous embolism myelopathy the most likely diagnosis. We postulated that some cases of transverse myelitis might actually be fibrocartilaginous embolism, making it a more prevalent cause of an acute myelopathy than commonly recognized. Relevant literature and current theories regarding the pathogenesis of fibrocartilaginous embolism myelopathy are reviewed.     

Comparison of Tenecteplase with Alteplase on clinical rating scores following small clot embolic strokes in rabbits

Tenecteplase (TNK) was engineered to have increased fibrin specificity and an increased half-life compared to Alteplase. Although Tenecteplase is currently being tested in a Phase II clinical trial in acute ischemic stroke patients, little is known about the pharmacology and dose-response or therapeutic window for Tenecteplase in embolic stroke models. In the present study, we compared Tenecteplase with Alteplase on behavioral outcome in rabbits with embolic strokes. Male New Zealand white rabbits were embolized by injecting a suspension of small blood clots into the middle cerebral artery (MCA) via a catheter. The rabbit small clot embolic stroke model (RSCEM) was used for a dose-response profile analysis of Tenecteplase (0.1 mg/kg-3.3 mg/kg) and Alteplase (0.9 mg/kg-3.3 mg/kg) given intravenously 1 h following embolization. In additional studies, Tenecteplase (0.9 mg/kg) or Alteplase (3.3 mg/kg) was administered 3 (or 6) h following embolization to determine the therapeutic window for the thrombolytics. For both studies, behavioral analysis was conducted 24 h following embolization, allowing for the determination of the effective stroke dose (P50) or clot amount (mg) that produces neurological deficits in 50% of the rabbits. Using the RSCEM, a drug is considered beneficial if it significantly increases the P50 compared with the control group. The P50 of controls 24 h after embolization was 1.13 +/- 0.15 mg. Rabbits treated 1 h post-embolization with Tenecteplase (0.1, 0.25, 0.9, 1.5 or 3.3 mg/kg) had P50 values of 1.48 +/- 0.33, 2.20 +/- 0.44, 2.76 +/- 0.37, 2.15 +/- 0.29 and 2.78 +/- 0.31 mg, respectively. In Alteplase-treated rabbits, only the 3.3 mg/kg dose significantly increased the group P50 by 189% compared to control. Tenecteplase was also effective at increasing the P50 value to 2.21 +/- 0.43 mg if there was a 3-h delay following embolization, but not if there was a 6-h delay before administration. Alteplase was only effective if administered 1 h following embolization where it significantly increased the P50 value to 3.27 +/- 0.40 mg. This study indicates that Tenecteplase has a wide therapeutic range, a therapeutic window of at least 3 h and a durable effect. Moreover, the safety profile for Tenecteplase is similar to that of Alteplase. Tenecteplase does not increase the rate of intracerebral hemorrhage (ICH) above that produced by Alteplase. However, the therapeutic range and window for Alteplase is more limited than that for Tenecteplase. Our preclinical studies suggest that Tenecteplase has a better pharmacological profile than Alteplase and supports further investigation of Tenecteplase in randomized double-blinded clinical trials in stroke patients.     

MRI findings in a child with sigmoid sinus thrombosis following mastoiditis

We describe the MRI features of sigmoid sinus thrombosis following mastoiditis in a 3-year-old girl. The features consisted of increased signal from the sinus on T2-weighted images and absence of flow on MR venography. It is concluded that MRI enabled a timely diagnosis of this life-threatening disease. MRI, as a non-invasive technique that does not use ionizing radiation, should be considered the investigation of first choice, especially in young patients.     

急性上肢动脉栓塞的外科治疗

目的：探讨急性上肢动脉栓塞的外科治疗方法和影响预后的因素。方法：回顾性分析肱动脉切开、Fogarty导管取栓术18例。结果：术后同时及桡动脉和尺动脉博动者8例,及桡动脉或尺动脉1支博动者9例,余1例皮温改善、肌力IV级,无术后患肢坏疽,死亡3例。结论：肱动脉切开取栓术治疗急性上肢动脉栓塞的疗效好,高龄、心肺疾病是术后死亡的高危因素。     

继发性脾功能亢进症介入疗法的研究

随着微创技术在国内外的迅速兴起,各种疾病的治疗观念在不断改变。在继发性脾功能亢进的治疗领域也出现了许多方法,如选择性脾动脉栓塞术、射频消融术、微波消融术等,这些方法各有优缺点,微创技术必将在临床脾亢的治疗中发挥重要的作用。     

手术丝线段栓塞脾动脉治疗婴幼儿地中海贫血

目的:寻找简单易行,不良反应较轻的临床治疗婴幼儿地中海贫血方法.方法:以7号手术丝线段作栓塞物,以庆大霉素与生理盐水混合液作灌注液.结果:所有用丝线段栓塞的患儿术后发热,上腹疼痛,恶心、呕吐等临床反应均较轻,未发现一例脾脓肿,一过性高血压及急性胰腺炎等并发症.结论:该方法简单易行,不良反应小.     

妊娠期生殖道感染所致产科脓毒症合并羊水栓塞分析并文献复习

目的探讨妊娠期生殖道感染(RTI)所致产科脓毒症合并羊水栓塞(AFE)患者的临床表现、诊断、治疗及预后，并进行相关文献复习。 方法选择2021年9月，于成都市第五人民医院住院、分娩的1例临床诊断为妊娠期生殖道光滑念珠菌感染所致产科脓毒症合并AFE患者为研究对象。采用回顾性研究方法，收集本例患者的临床病例资料，并对其临床表现、诊断及治疗经过进行分析。以"妊娠期生殖道感染""产科脓毒症""羊水栓塞""reproductive tract infection during pregnancy""obstetric sepsis""amniotic fluid embolism"为关键词，在中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普中文科技期刊数据库、万方数据知识服务平台及PubMed与Ovid Medline数据库中，检索妊娠期RTI所致产科脓毒症合并AFE相关文献。文献检索时间设定为上述数据库建库至2021年10月。总结妊娠期RTI所致产科脓毒症合并AFE患者的临床表现、诊断与治疗。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。 结果①本例患者分娩年龄为38岁，2021年9月8日7：20 am，因"停经31⁺¹周，反复阴道流血12⁺ h，加重2 h"，于病例收集医院住院治疗。入院时，胎儿超声检查结果提示，宫内单活胎、头位、胎盘前置；患者血常规提示，白细胞计数、中性粒细胞百分比均增高，分别为11.6×10⁹/L与94.5%；阴道分泌物病原体培养与鉴定结果提示，光滑念珠菌感染。入院当天9：40 am，患者体温为37.9 ℃，采取头孢呋辛抗感染治疗、硫酸镁保护胎儿中枢神经系统、地塞米松促胎肺成熟等对症支持治疗。入院第2天，为进一步明确感染源，持续面罩吸氧下拟进行胸部CT时，患者突发呼吸困难，阴道大量羊水流出，10 min后，患者全身发绀、瘫软，四肢厥冷、牙关紧闭、意识丧失，立即进行气管插管、心电监护提示：脉搏为120次/min，血压为74 mmHg/42 mmHg(1 mmHg＝0.133 kPa)，脉搏血氧饱和度(SpO₂)为70%，胎心率为57次/min，立即采取急诊剖宫产术分娩。术中母体血常规检查结果提示：血红蛋白为116 g/L(正常)，血小板计数为35×10⁹/L(低于正常参考值)；凝血酶原时间为19.9 s，国际标准化比值为1.72，部分凝血活酶时间>180.0 s，凝血酶时间>180.0 s，纤维蛋白原降解产物为189.65 μg/mL(均高于正常参考值)；纤维蛋白原为0.49 g/L(低于正常参考值)。胸腔积液及血液病原体培养结果均提示，革兰阴性杆菌呈阳性。临床拟诊为脓毒症引起休克，AFE、弥散性血管内凝血(DIC)。遂对其进行全子宫切除术+左侧输卵管切除术(右侧输卵管既往已被切除)。术后转入重症监护病房，在多学科团队协作下，采取连续性肾脏替代疗法(CRRT)稳定内环境、输血治疗、管理血容量、升高血压，糖皮质激素抗炎、抗免疫，曲前列尼尔降低肺动脉压，亚胺培南西司他丁抗感染，抑制胃酸分泌，间断进行血液净化治疗减轻炎症反应，体外膜肺氧合(ECMO)改善氧供及亚低温治疗等。由于患者同时合并产科脓毒症与AFE，病情进展迅速，于产后23 d因抢救无效死亡。②按照本研究制定的文献检索策略进行文献检索结果显示，无一例关于妊娠期RTI所致产科脓毒症合并AFE患者救治的文献报道。 结论妊娠期RTI发生率高，但是RTI后突发AFE的病例报道罕见。临床对妊娠期RTI孕产妇积极、规范抗感染治疗，可预防产科脓毒症及AFE。对于妊娠期RTI所致产科脓毒症合并AFE患者的治疗，因涉及多器官功能衰竭(MOF)，需要多学科团队协作改善患者预后。