Multimodal management of ruptured cerebral micro-arteriovenous malformations: A retrospective series of 19 cases and a review of the literature

BackgroundMicro-arteriovenous malformations (micro-AVMs) are defined as AVMs just visible on angiography with a nidus size between 0.5 and 1 cm. Their principal manifestation is intracranial hemorrhage and their diagnosis and therapeutic management are still unclear.MethodsThe aim of our work was to show the clinical presentation, treatment and outcome of ruptured cerebral micro-AVMs in a retrospective cohort study of 19 patients and a systematic review of the literature.ResultsWe obtained a total of 20 micro-AVMs in 19 patients. The mean age was 47.3 years. Clinical presentation was acute bleeding. The mean volume of hematoma was 12.9 mm³ (0 - 60.4), with topographic distribution as follows: 64% cortical with supratentorial bleeding, 26% deep, and 10% in the posterior fossa. Among the 20 micro-AVMs of the series, 11 (55%) had endovascular management, 6 (30%) had surgical treatment and 3 (15%) had GK radiosurgery alone. All of our patients have been cured at the end of the follow up without re-permeabilization. In our series, clinical outcome showed good recovery with a mean score of 4.6 on Glasgow Outcome Scale (GOS). In the literature, 88% of patients had a GOS of 4 or 5.DiscussionIntracerebral hematoma (ICH) was the main clinical manifestation. In the case of negative initial angiographic assessment, patients must have supraselective angiographic exploration. In the case of conservative treatment of hematoma, endovascular obliteration and microsurgical exclusion seems to be reasonable therapeutic options, according to our observations.     

丹参提取物F对胃粘膜失血／再灌注损伤的保护作用

按Ｉｔｏｈ法复制了大鼠胃粘膜失血（休克）／再灌注损伤模型。结果显示，再灌注后胃粘膜有明显的出血性损伤；静注丹参提取物Ｆ可明显降低粘膜损伤数（Ｐ＜０．０１）及细胞内钙含量（Ｐ＜０．０５）；增加６－Ｋｅｔｏ－ＰＧＦ１ａ／ＴＸＢ２比值（Ｐ＜０．０１）。提示：丹参提取物Ｆ对胃粘膜失血（休克）／再灌注损伤具有明显的保护作用，这下减轻细胞内钙超载，增加６－Ｋｅｔｏ－ＰＧＦ１ａ／ＴＸＢ２比值有关。     

经皮肾镜去石术后出血的介入治疗

目的: 研究超选择性肾动脉栓塞在治疗经皮肾镜术后出血中的效果及失败原因。方法: 对65例伴有血液动力学改变的经皮肾镜术后出血患者行肾动脉造影,用微导管行超选择性插管,用微弹簧圈栓塞损伤动脉。若首次肾动脉造影无阳性发现,则采用以下措施以防止遗漏病灶:(1)腹主动脉造影;(2)重复肾动脉造影;(3)造瘘管走行区域肾动脉分支超选择造影;(4)保留穿刺通道,拔除肾造瘘管后造影。对肾动脉出血的造影表现进行总结,并对栓塞止血失败的原因进行分析。结果: 65例患者中,造影有阳性发现的60例(62个肾脏), 均经超选择性栓塞成功止血。肾动脉造影的阳性表现包括:假性动脉瘤形成、斑片状造影剂外溢、假性动脉瘤合并动静脉瘘、造影剂进入集合系统、造影剂弥散至肾被膜下。一次栓塞成功53例(55个肾脏), 成功率88.71%,两次栓塞成功率96.77%。首次栓塞失败的原因主要是遗漏病灶(4例,57.10%)和栓塞的受损血管再通(2例,28.57%)。5例患者肾动脉造影无阳性发现,经保守治疗血尿停止。所有患者介入治疗后3、6、12个月随访,均未再次出现血尿,且未发生持续、严重的肾功能损害。结论: 超选择肾动脉栓塞是治疗经皮肾镜术后出血的有效方法,肾动脉造影遗漏病灶是造成止血失败的主要原因。     

Periventricular- intraventricular hemorrhage in the premature infant- A historical perspective

The objective of this chapter is to trace the evolution of intraventricular hemorrhage in the premature infant highlighting the importance of the germinal matrix, a critical role for cerebral blood flow changes in the genesis of hemorrhage, clinical factors that increase the bleeding risk, and potential preventative strategies. In 1976, neuropathological studies demonstrated capillary rupture within the germinal matrix as the precursor of hemorrhage. In 1980, introduction of cranial ultrasound facilitated diagnosis of intraventricular hemorrhage. In 1979, loss of cerebral autoregulation in sick newborn infants was demonstrated. In the 1980’s, studies demonstrated the importance of intravascular factors in provoking hemorrhage. In 1983, the association of cerebral blood flow velocity fluctuations and subsequent hemorrhage was demonstrated. In 1994, antenatal steroids use to accelerate lung development was recommended. This was associated with an unanticipated reduction in hemorrhage. In the mid 1990’s early indomethacin administration was associated with a reduction of severe hemorrhage.     

肝移植术后出凝血功能的调控

目的：探讨肝移植术后出凝血功能的调控方法及意义。方法：通过１１ 例活体肝部分移植术病例,介绍术后出凝血功能的监测指标及调控方法。结果：肝移植术后出凝血功能调控的目标为维持血压、脉搏相对稳定,控制下列指标在一定范围内。 Ｈｂ ：９０ ～１１０ｇ／ Ｌ, Ｈｔ：２５ ％ 上下, Ｐ Ｌ Ｔ：３０ ～５０ ×１０９／ Ｌ, Ｐ Ｔ：１５ ～２０ｓ , Ａ Ｃ Ｔ：１５０ ～２００ｓ,调控手段是依据上述指标补充凝血因子或使用扩血管剂或抗凝剂。结论：本研究所介绍的方法能有效防止肝移植术后的出血和血栓形成。     

针刺对急性高血压脑出血大鼠血浆ET和CGRP调整作用

目的：探索针刺对急性高血压大鼠治疗作用机制。方法：复制急性高血压脑出血大鼠模型。观察针刺对血浆ET和CGRP的影响。结果：针刺能降低血浆ET和升高CGRP。结论：针刺对急性高血压脑出血大鼠治疗作用与其降低血浆ET和CGRP密切相关。     

生长抑素治疗食管静脉曲张破裂出血30例疗效分析

目的：观察生长抑素治疗食管静脉曲张破裂出血的疗效。方法：治疗组30例用生长抑素静滴维持，对照组30例用垂体后叶素及硝酸甘油静滴维持。结果：治疗组48h内止血27例，止血率为90％，对照组48h止血16例，止血率为53．3％。两组相比止血率有非常显著性差异（P＜0．01）。结论：生长抑素治疗食管静脉曲张破裂出血，具有止血速度快，止血率高及无明显副作用等优点，疗效优于垂体后叶素。     

Inhibition of hemorrhagic and edematogenic activities of snake venoms by a broad-spectrum protease inhibitor, murinoglobulin; the effect on venoms from five different genera in Viperidae family.

In order to obtain basic data on the effect of broad-spectrum protease inhibitor against local symptoms of Viperidae snake envenomation, inhibitory capacity of rat murinoglobulin on local hemorrhagic and edematogenic activities of venoms from Crotalus atrox, Bothrops jararaca, Lachesis muta muta, Trimeresurus flavoviridis and Echis carinatus sochureki were examined. Murinoglobulin, pre-incubated with the crude venoms at 37 degrees C for 15 min, inhibited hemorrhagic activity of all five venoms to various extents. The activity of C. atrox was almost completely inhibited at the murinoglobulin/venom ratio (w/w) of 20. The activity of B. jararaca, Lachesis muta muta and T. flavoviridis venoms was considerably inhibited at the ratio of 20 (77.2, 80.0 and 86.2% inhibition, respectively), however some of the activity still remained even at the ratio of 40 (84.2, 79.8 and 86.2% inhibition, respectively). Among the five venoms, E. c. sochureki venom is quite resistant to murinoglobulin treatment and statistically significant inhibition was only found at the ratio of 40 (64.1% inhibition). Fibrinolytic and gelatinase activities were more susceptible to murinoglobulin inhibition. The treatment at the ratios of 10 and 20 almost completely inhibited respectively the fibrinolytic and the gelatinase activities of all the venoms. Murinoglobulin treatment also significantly inhibited the edematogenic activity of L. muta muta, T. flavoviridis and Echis carinatus sochureki. The treatment of murinoglobulin at the ratio of 40 considerably suppressed the swelling up to 60 min after subcutaneous injection of L. muta muta and E. c. sochureki venoms, and up to 30 min after T. flavoviridis venom injection. Murinoglobulin is a potent inhibitor against local effects of multiple snake venoms in Viperidae family.     

Hemorrhagic activity of Bothrops venoms determined by two different methods and relationship with proteolytic activity on gelatin and lethality

The changes in hemorrhagic activity, proteolytic activity on gelatin and the lethal potency of four Bothrops venoms treated at different pH values or with EDTA were studied. Venoms from B. alternatus, B. jararaca, B. moojeni and B. neuwiedii of Argentina were preincubated at pH 5.8, 5.1 or 3.8 or with EDTA and the hemorrhagic activity expressed as size of the hemorrhagic lesion or as the amount of hemoglobin extracted, the proteolytic activity on gelatin and the lethal potency were determined. Although the MHDs recorded in rats were 19–56 fold higher than those recorded in mice, the A₅₅₀ extracted per gram of hemorrhagic haloes was very similar in rats or mice independent of the venom dose. Inhibition of proteolytic activity after preincubation at pH 5.1 or 3.8, agrees with the decreased amount of hemoglobin extracted from the hemorrhagic haloes, and with the increase in mean survival time after the i.p. injection to mice. Preincubation with EDTA resulted in 80% inhibition of hemorrhagic activity of B. jararaca venom and complete inhibition with the other Bothrops venoms tested. Measurement of the amount of hemoglobin extracted gives significant information in comparative studies, not available by measurement of the size of hemorrhagic haloes.     

辨证治疗中风病248例临床分析

本文通过对２４８例中风病临床分型分析，以气虚血瘀证最多，占３８．３１％，其次为阴虚风动证，肝阳暴亢，风火上扰证。本组病人不论是出血性中风，还是缺血性中风，均采用中药辨证治疗基础上，口服中成药及静脉滴注活血化瘀针剂以加强活血化瘀、涤痰通络这一治疗法则，总有效率为８４．２７％，其中出血性中风和缺血性中风的总有效率分别为８６．９５％和８３．２４％，对血液流变学、脑出血患者治疗前后脑ＣＴ对照观察，认为 一