Saddle Arterial Embolus in a Patient with Down Syndrome

We report acute thromboembolic events in a 14-year-old boy with Down syndrome and repaired atrioventricular septal defect. He presented with sudden onset of bilateral lower limb ischemia. Transesophageal echocardiography detected a thrombus in the right atrium. An arterial saddle embolus was removed following bilateral iliac embolectomy. Despite anticoagulation, he presented again with sudden bilateral loxwer limb ischemia and respiratory distress. Multiple pulmonary emboli and a thrombus in the right atrium were noted on imaging studies. An arterial embolus was removed from the abdominal aorta at the bifurcation. To our knowledge, this is the first report of a child or adolescent with a repaired congenital heart lesion and arterial embolism requiring embolectomy. This association and possible etiological factors are discussed.     

~(125)Ⅰ-LUF体毛导向治疗晚期肝癌初步报告

将标记放射性同位素~(125)I 的超液态碘化油(~(125)I-LUF)及自身体毛颗粒混入抗癌药,经导管超选择灌人供瘤动脉,治疗20例肝癌。在这种导向治疗前后分别作 CT、B 超、DSA 及 AFP 等对照检测及~(125)I 放射性测定。结果证明~(125)I 能牢固标记于 LUF,与体毛一起在100μm 直径以下的供瘤末梢动脉中长期滞留,不通过毛细血管进入全身循环,并能将抗瘤药限制在肿瘤局部发挥近距离长时间内照射化疗栓塞作用,对癌外正常组织损伤最小,术后副作用较轻,未发生排异反应,临床疗效满意。     

螺旋CT动态增强扫描对肝细胞癌合并门静脉癌栓的诊断价值(附32例分析)

目的探讨肝细胞癌合并门静脉癌栓发生机制和螺旋CT动态增强扫描的表现。方法32例肝细胞癌门静脉癌栓形成的患者作螺旋CT平扫和增强扫描,10例进行了多平面重组(MPR)成像,9例患者治疗后作CT随访。结果螺旋CT轴位和MPR图像能清晰显示门静脉癌栓,直接的CT征象为门静脉增粗及充盈缺损,门脉血管软组织肿块影和门静脉癌栓内及周围可见网状供血动脉。间接征象主要有侧支循环形成及周围肝脏动力学的改变。螺旋CT扫描可以评价门静脉癌栓治疗后的变化情况。结论螺旋CT动态增强扫描轴位图像结合MPR可以完整地提供门静脉癌栓的影像资料,对肝细胞癌患者治疗方法的选择及预后判断具有重要价值。     

Bezoars,stones, thrombi,thrombophlebitis, emboli,vascular disorders,paralytic ileus,intercellular extravascular glue and dessication: Fundamental physical factors in the formation of concretions

Usually blood does not stagnate nor clot in its vessels. Spasm in a vein or artery, constricting the wall or sphincter, seines and assembles the ingredients of a thrombus. It further leads to rupture of the vessel's wall, so extravascular glue can complete or augment the recipe. The mechanisms of blood clotting, include three prime factors, stasis, dessication and extravascular glue. Idiopathic disorders of the arteries and veins are similar to each other and to those in other systems and, e.g. analogous to paralytic ileus and intestinal obstruction. Dissecting, i.e. intralaminar hemorrhage in the pathogenesis of emboli, venous/arterial and vascular occlusion, merits more attention as do the sphincters and valves of the vascular system.     

16层螺旋CT肺动脉造影对肺栓塞诊断价值及对栓子显示情况的研究

目的探讨16层螺旋CT肺动脉造影对肺栓塞（PE）的诊断价值,并研究其对栓子的显示情况,以提高对PE的诊断水平。方法 2010年1月~2014年4月接收的127例PE疑似患者为研究对象,所有病例均行16层螺旋CT肺动脉造影、肺动脉造影、肺部CT平扫、胸部X线平片,比较4种检测方法的诊断结果,并比较16层螺旋CT肺动脉造影、肺部CT平扫、胸部X线平片的灵敏度、特异度、阳性预测值、阴性预测值、诊断准确率。观察、记录16层螺旋CT肺动脉造影对主肺动脉、肺动脉干,叶、段、亚段肺动脉的分支数及栓子的类型、数量显示情况。结果 127例PE疑似患者经肺动脉造影确诊89例,除外38例;16层螺旋CT肺动脉造影阳性85例,阴性42例（其中假阴性4例）;肺部CT平扫阳性69例（其中假阳性16例）,阴性58例（其中假阴性36例）;胸部X线平片阳性50例（其中假阳性13例）,阴性77例（其中假阴性52例）。16层螺旋CT肺动脉造影对肺栓塞的灵敏度、特异度、阳性预测值、阴性预测值及诊断准确率均显著高于肺部CT平扫、胸部X线平片（P〈0.05）。16层螺旋CT肺动脉造影共显示肺动脉干、左/右肺动脉,叶、段、亚段肺动脉3588支,肺动脉栓塞940支,栓塞率为26.2%。各动脉栓塞率从大到小依次为：亚段肺动脉（30.0%）〉叶肺动脉（29.4%）〉段肺动脉（26.8%）〉左/右肺动脉（12.2%）〉肺动脉干（8.1%）。栓子类型从大到小依次为：偏心型（497）〉附壁型（155）〉中心型（154）〉完全堵塞型（134）。结论16层螺旋CT肺动脉造影诊断PE具有较高的灵敏度、特异度和准确度,能清晰地显示栓子的类型和数量,值得临床推广应用。     

猪脂肪栓塞模型的经食管超声心动图实验研究

目的经食管超声心动图（transesophageal echocardiography，TEE）观察猪心腔中脂肪栓子的超声表现及猪脂肪栓塞的致死量。方法实验用健康梅白猪6头，均经猪颈内静脉每隔40min依次缓慢注入0．1、0．2……12．0ml的同种脂肪液，用TEE连续观察心腔内图像变化，记录脂肪栓塞的致死量。结果随着注入的脂肪量增加，TEE显示右心腔游动的点状强回声增多，由星点状变为阵雨或雪花飞舞状，排空时间延长，脂肪注入量大于4ml后点状强回声可出现于左心室。猪脂肪栓塞的累积致死量为15．8～27．8ml。结论TEE可观察心腔内脂肪栓子的动态变化，出现反常栓塞是脂肪栓塞发展为脂肪栓塞综合征的可靠证据，猪脂肪栓塞的平均累积致死量为（17．8±4．9）ml。     

Quantification of Embolic Showers Using Radio-Frequency Based TCD Analysis

During cardiac surgery and cardiology interventions, microemboli may be generated and disperse in the systemic circulation. The amount of microemboli that ends up in cerebral blood vessels is associated with postoperative neurologic complications. During cardiac surgery a large amount of cerebral microemboli can occur at once and create so-called “cerebral embolic showers.” To correlate postoperative neurologic outcome to cerebral embolic load, a quantitative evaluation of these embolic showers is necessary. The standard monitoring technology to visualize cerebral microemboli is transcranial Doppler (TCD). Although the conventional TCD systems are equipped with software claiming to detect microembolic signals, none of the existing TCD systems is capable of an accurate estimation of the number of cerebral microemboli in embolic showers. In this study, an algorithm with a high temporal resolution, based on the radiofrequency (RF) signal of a TCD system, has been designed to quantify these showers. Evaluation by three independent observers of a training set demonstrates that the proposed method has a sensitivity of at least one order of magnitude better than the automatic detection algorithm on the existing Doppler device used. RF-based emboli detection can possibly become a standard addition to conventional Doppler methods, considering that accurate estimation of the embolic load supports quantification of neurologic risk during various surgical procedures. (E-mail: l.sauren@ctc.unimaas.nl)     

选择性盆腔动脉插管灌注栓塞及化疗治疗晚期妇科恶性肿瘤

用改良的Ｓｅｌｄｉｎｇｅｒ’ｓ插管技术对４６例经病证实的晚期妇科恶性肿瘤进行了选择性盆腔动脉插管栓塞及化疗治疗，其中７例为手术前患者，因癌块大，粘连严重，故先行插管治疗，术中证实癌块明显缩小，盆腔粘连带软化，８例为术后复发患者经的插管化疗或栓塞治疗后，复发癌块直径缩小５０％以上者占７５％，３１例为术后患者，行动脉插管化疗巩固疗效，毒副作用较静脉化疗轻，提出本方法不仅可为晚期难以施实手术的妇科恶性肿