Choroid plexus cysts-Association with trisomy: Prospective review of 16,059 patients

OBJECTIVE: The purpose of the study was to determine the incidence of isolated choroid plexus cysts in association with trisomy 18 and other abnormalities.STUDY DESIGN: All patients from June 1992 through December 1995 were followed up after a screening ultrasonography. Any patient with a choroid plexus cyst was offered genetic counseling and an amniocentesis. Screening ultrasonographic examinations were performed on 16,059 patients, and 301 patients had a fetus with a choroid plexus cyst. One hundred thirty patients elected to have an amniocentesis. Patients were followed up to delivery.RESULTS: Two hundred sixty-three patients had an isolated choroid plexus cyst. Thirty-eight patients had a choroid plexus cyst associated with additional risk factors. Risk factors included advanced maternal age, additional ultrasonographic abnormalities, past obstetric history, or family history. No abnormalities were noted in the group with an isolated choroid plexus cyst. Four patients had an abnormality when the choroid plexus cyst was associated with an additional risk factor, including two patients with trisomy 18 and one with trisomy 21.CONCLUSION: An isolated choroid plexus cyst was not associated with a trisomy or other abnormalities in this study. When a choroid plexus cyst was associated with an additional risk factor, 10.5% of the patients had an abnormality. Amniocentesis is recommended when a choroid plexus cyst is found in association with additional risk factors. (Am J Obstet Gynecol 1997;176:1381-3.)     

Analysis thrombolysis with anticoagulation treatment for early stage of deep vein thrombosis in the lower extremities

Objective:To explore the effect of thrombolysis with anticoagulation treatment forearly stage of deep vein thrombosis of lower extremity.Methods:The clinical data of 10 patients at the early stage of deep vein thrombosis(DVT)in the lower extremuites treated by thrombolysis with anticoagulation and dispersion drugs were analyzed retrospectively.Results:The thrombolytic effect was significant.After treatment,the deep veins were recanalized without regurgitation in 75.3% of the patients.The total effective rate was 100%.Only three patients had hemorrhagic complication,but none of the patients died.Conclusion:Thrombolysis with anticoagulation treatment is an effective and safe method for DVT at the early stage.     

急性肠系膜静脉血栓形成16例临床分析

目的　分析急性肠系膜静脉血栓形成 (ASMVT)的临床特征和诊断方法。方法　对北京友谊医院 1985年 10月至 2 0 0 2年 10月确诊的 16例ASMVT的临床资料进行分析 ,并结合文献 ,总结ASMVT的临床特征和诊断方法。结果 16例ASMVT患者 ,年龄 19～ 6 4岁 (平均 4 5 9岁 )。主要症状有腹痛 ( 16 / 16 )、腹胀 ( 16 / 16 )、呕吐 ( 10 / 16 )、发热 ( 8/ 16 ) ,主要体征有腹部膨隆 ( 16 / 16 )、腹膜刺激征( 16 / 16 )。误诊率 75 % ( 12 / 16 ) ,死亡率 4 4 % ( 7/ 16 )。结论　ASMVT的临床表现有一定的特征 ,早期彩色超声检查、诊断性腹腔穿刺、结合CT或肠系膜上动脉造影异常发现可对ASMVT做出正确的诊断 ,早期手术可以降低死亡率     

健侧C7移位至桡神经治疗全臂丛神经根性撕脱伤改良术的解剖学基础

目的寻求健侧C7神经根移位治疗全臂丛神经根性撕脱伤手术中尺神经与桡神经的最佳吻合部位。方法在10具20侧福尔马林固定的成人尸体上肢标本上观察桡神经及其肱三头肌肌支的解剖学特征;尺神经的解剖学特征;尺神经不同水平与对侧颈根部的距离。结果桡神经从后侧束发出部位到发出肱三头肌长头的第一支肌支之间的距离为(8.2±1.4)cm,从发出长头的第一个肌支部位到外侧头最后一个肌支发出部位之间的距离为(4.8±0.7)cm。尺神经肘部以上几乎无分支,尺神经在发出部位的直径为(6.7±0.6)mm;在肘部的直径为(6.3±0.5)mm;在腕部的直径为(4.0±0.4)mm;从锁骨下尺神经发出部位到肘部的长度为(29.0±2.6)cm;从锁骨下尺神经发出点到对侧颈根部的距离为(18.0±1.8)cm。结论健侧C7神经根移位修复桡神经,尺神经与桡神经的最佳吻合部位是锁骨下区,在此部位吻合不但能保证肱三头肌功能恢复,而且大大缩短桥接神经的长度。     

上矢状窦旁脑膜瘤致上矢状窦阻塞时侧支静脉通路的意义

目的 分析上矢状窦旁脑膜瘤致上矢状窦(SSS)阻塞时其侧支静脉通路的建立情况，确定其在肿瘤切除术中的意义。方法 总结归纳86例上矢状窦旁脑膜瘤行MRA及DSA检查时的静脉系表现。结果 27例发生SSS完全阻塞，59例部分阻塞。18例在阻塞的SSS周围出现了由表浅皮层静脉所形成的侧支静脉环；通过表浅皮层静脉与蝶顶窦及小脑幕静脉系建立端—端吻合的16例；通过与Troland或Labbe静脉建立吻合的14例；通过大脑镰与下矢状窦吻合的9例；通过脑膜静脉并经板障静脉引流到颈外静脉系的17例；混合型12例。结论 上矢状窦旁脑膜瘤致SSS阻塞时，肿瘤周围存在广泛侧支静脉通路，术中应注意保护。脑DSA及MRA检查对术前了解SSS通畅性及侧支静脉通路建立有帮助。     

CT引导下无水乙醇阻滞双侧腹腔神经丛治疗腹部癌性疼痛的评价

目的探讨CT引导下腹腔神经丛无水乙醇阻滞治疗腹部癌性疼痛的价值。方法对无法切除和无法有效止痛的12例晚期上腹部癌症病例，CT引导下以无水酒精10-15毫升实施双侧腹腔神经丛阻滞。评价其止痛效果、不良反应、生存质量等。结果疼痛完全缓解7例，部分缓解3例，患者仅口服或肌注曲马多即能止痛．有效率83.3％；6例完全或部分缓解持续3个月，1例持续4．3个月。全部病例精神状态、饮食和睡眠明显好转。结论CT引导下腹腔神经丛无水乙醇阻滞可较有效地解除上腹部顽固性的癌性疼痛。     

骨科住院患者下肢深静脉血栓形成的危险因素及相关性分析

目的探讨骨科住院患者下肢深静脉血栓形成(lower extremity deep vein thrombosis,LD-VT)的危险因素。方法2003年8月~2006年8月收治的350例骨科住院患者中,确诊为LDVT者38例,对其相关因素进行回顾性分析。结果27项单因素相关分析中有9项有显著性意义,经Logis-tic回归分析显示,危险因素为:血浆D-二聚体、纤维蛋白原、血管性血友病因子阳性,4周内有手术史以及有外伤史。结论对上述危险因素存在的骨科住院患者,应警惕LDVT发生,如有D-二聚体测定阳性等危险因素应予预防性治疗。     

Characterization of an immunologic polymorphism (D79H) in the heavy chain of factor V.

BACKGROUND: During the study of a family with hereditary factor (F)V deficiency (FV Amersfoort, 1102 A > T in exon 7) we identified an individual with 5% FV heavy chain antigen (FV(HC)) and 50% FV light chain antigen (FV(LC)). Further testing revealed that apart from the FV Amersfoort allele a second variant FV allele was segregating in this family, which encodes for a FV molecule with a reduced affinity for mAb V-23 used in the FV heavy chain ELISA (ELISA(HC)). OBJECTIVE: Identification and characterization of the molecular basis responsible for the reduced affinity of the variant FV for mAb V-23. METHODS: Family members of the proband were screened for mutations in the exons coding for the heavy chain of FV, after which the recombinant variant FV could be generated and characterized. Next, the cases and controls of the Leiden Thrombophilia Study (LETS) were genotyped for carriership of the variant FV. RESULTS: In the variant FV allele a polymorphism in exon 3 (409G > C) was identified, which predicts the replacement of aspartic acid 79 by histidin (D79H). Introduction of this mutation in recombinant FV confirmed that it reduces the affinity for binding to mAb V-23. The substitution has no effect on FV(a) stability and Xa-cofactor activity. In Caucasians the frequency of the FV-79H allele is approximately 5%. Analysis of the LETS revealed that the FV-79H allele is not associated with FV levels (FV(LC)), activated protein C sensitivity (using an activated partial thromboplastin time-based test) or risk of venous thrombosis (OR 1.07, CI 95: 0.7-1.7). CONCLUSION: The D79H substitution in FV should be considered as a neutral polymorphism. The monoclonal antibody V-23, which has a strongly reduced affinity for FV-79H, is not suitable for application in diagnostic tests.     

下肢深静脉瓣功能不全的二维及彩色多普勒超声诊断

目的 探讨下肢深静脉瓣功能不全的二维及彩色多普勒超声声像图改变。方法 应用二维及彩色多普勒超声检查下肢深静脉瓣功能不全36例，47条腿，观察下肢静脉血管及瓣膜的解剖结构和血流动力学改变。结果 有静脉瓣功能不全的患肢静脉管腔内径均有不同程度增宽，瓣膜均有不同程度的改变，脉冲多普勒显示返流频谱返流时间大于0.5s。结论 该检查对诊断下肢深静脉瓣功能不全有较高的实用价值。