老年人急性心肌梗死82例临床分析

目的：总结老年人急性心肌梗塞（ＡＭＩ）静脉溶栓治疗经验。方法：对８２例老年人ＡＭＩ的临床资料及其中７５例的溶栓治疗资料进行分析。结果：老年人ＡＭＩ时,无胸痛史达５４．９％,入院心电图ＳＴ－Ｔ缺乏典型改变占４５．３％。经静脉溶栓治疗,梗塞动脉开通率为６２．９％,与７０岁以下ＡＭＩ组溶栓开通率比较（６５％）,无统计学差异。结论：老年人ＡＭＩ发病时,临床表现及心电图改变常不典型,应引起重视。在本文条件下     

A Bullet Embolism to the Right Popliteal Artery Following an Abdominal Gunshot Wound

Abstract Bullet emboli are uncommon complications of gunshot injuries. Their rarity and the potential lack of early symptoms frequently lead to delays in diagnosis and inadequate early management that can result in loss of limb or life. However, the rise in civilian trauma from low-velocity gunshot wounds increases the likelihood of encountering them.This report describes a case in which a small-caliber bullet penetrated the anterior wall of the abdominal aorta and then traveled into the right popliteal artery eventually embolizing this vessel. Although the patient was initially asymptomatic, the eambolism was diagnosed at a very early stage and the projectile was surgically extracted leaving the patient without any impairment.     

Incomplete lacunar infarction (Type I b lacunes)

The aetiopathogenesis of small, deep (lacunar) infarcts remains controversial. The view that they are caused by occlusive intrinsic small vessel disease is widely held, but is based on only a small number of detailed pathology studies. We describe and illustrate a variant of small, microvessel-associated basal ganglia lesion, the histopathological features of which are distinct from those of classical Types I, II and III lacunes. Their appearances suggest a state of incomplete infarction. The pathogenetic significance of such lesions is discussed, in particular the role of mechanisms causing temporary or only moderately severe ischaemia. Received: 21 October 1997 / Revised, accepted: 16 January 1998     

急性下肢动脉缺血的临床研究

目的 探讨急性下肢动脉缺血(ALLI)的治疗策略和预后.方法 回顾性分析2003年1月至2009年12月收治的ALLI患者的临床资料.结果 ALLI 130例,包括急性动脉栓塞82例和急性动脉血栓形成48例.单纯全身溶栓和抗凝治疗12例,Fogarty导管取栓81例,行取栓及动脉旁路术15例,9例行导管性溶栓,骨筋膜室切开减压27例.一期截肢13例;死亡9例,死亡率为6.9％,二期截肢8例;总体截肢率为19.3％(21/109).吸烟史、合并糖尿病和起病时间超过24小时是影响保肢的独立危险因素.结论 尽早开始治疗ALLI和选择适当的治疗方法有助于提高疗效.     

Automatic detection of emboli in the TCD RF signal using principal component analysis

The transcranial Doppler (TCD) radio-frequency (RF) signal can provide additional information on events recorded during ultrasonic monitoring. Embolic signals appear as uniform and predictable shapes within the RF signal, enabling pattern recognition and image processing techniques to be used for their automated detection. This paper uses principal component analysis (PCA) to characterise the typical variation in embolic signal shape, within the RF signal, using training sets of in vitro and in vivo data. PCA techniques are then utilised to discriminate between previously unseen embolic and artifact signals. Although the results of this study show that the algorithms described in this paper do not yet have the accuracy required for their use in a clinical setting, it does demonstrate that this novel technique has the potential to be developed further. (E-mail: dhe@le.ac.uk)     

超选性插管栓塞治疗宫颈妊娠的应用研究

目的：探讨经过导管的超选性插管到子宫内动脉栓塞在治疗宫颈妊娠方面的应用。方法：10例患有宫颈妊娠的患者经超选性子宫内动脉插管后再注射明胶海绵颗粒、MTX等药剂,栓塞后再联合刮宫术对其进行有效的治疗,术后观察所有患者的β-hCG的数值变化情况。结果：10例患者的栓塞以及双侧的子宫动脉插管的成功率均到达了100%,没有严重并发症发生。结论：经过导管的超选性插管到子宫内动脉栓塞治疗共宫颈妊娠可以很明显的降低丧失生育能力与子宫切除的危险。     

Fetal stroke and cerebrovascular disease: Advances in understanding from lenticulostriate and venous imaging,alloimmune thrombocytopaenia and monochorionic twins

Fetal stroke is an important cause of cerebral palsy but is difficult to diagnose unless imaging is undertaken in pregnancies at risk because of known maternal or fetal disorders. Fetal ultrasound or magnetic resonance imaging may show haemorrhage or ischaemic lesions including multicystic encephalomalacia and focal porencephaly. Serial imaging has shown the development of malformations including schizencephaly and polymicrogyra after ischaemic and haemorrhagic stroke. Recognised causes of haemorrhagic fetal stroke include alloimmune and autoimmune thrombocytopaenia, maternal and fetal clotting disorders and trauma but these are relatively rare. It is likely that a significant proportion of periventricular and intraventricular haemorrhages are of venous origin. Recent evidence highlights the importance of arterial endothelial dysfunction, rather than thrombocytopaenia, in the intraparenchymal haemorrhage of alloimmune thrombocytopaenia. In the context of placental anastomoses, monochorionic diamniotic twins are at risk of twin twin transfusion syndrome (TTTS), or partial forms including Twin Oligohydramnios Polyhydramnios Sequence (TOPS), differences in estimated weight (selective Intrauterine growth Retardation; sIUGR), or in fetal haemoglobin (Twin Anaemia Polycythaemia Sequence; TAPS). There is a very wide range of ischaemic and haemorrhagic injury in a focal as well as a global distribution. Acute twin twin transfusion may account for intraventricular haemorrhage in recipients and periventricular leukomalacia in donors but there are additional risk factors for focal embolism and cerebrovascular disease. The recipient has circulatory overload, with effects on systemic and pulmonary circulations which probably lead to systemic and pulmonary hypertension and even right ventricular outflow tract obstruction as well as the polycythaemia which is a risk factor for thrombosis and vasculopathy. The donor is hypovolaemic and has a reticulocytosis in response to the anaemia while maternal hypertension and diabetes may influence stroke risk. Understanding of the mechanisms, including the role of vasculopathy, in well studied conditions such as alloimmune thrombocytopaenia and monochorionic diamniotic twinning may lead to reduction of the burden of antenatally sustained cerebral palsy.     

冰茶栓对骨癌痛大鼠骨溶解的影响

目的观察冰茶栓对W256细胞诱导的骨癌痛大鼠骨溶解的影响。方法将40只雌性SD大鼠分为假手术组、模型组、邦罗力组及冰茶栓组,采用骨髓腔注射W256癌细胞复制骨癌痛模型;模型复制第13天开始,假手术组和模型组给予空白栓,邦罗力组给予邦罗力20μg/kg,冰茶栓组给予冰茶栓101mg/kg。末次给药后,对各组大鼠患肢进行X线摄片并评分以观察骨溶解情况,采用苏木精-伊红染色观察骨组织病理学变化,采用抗酒石酸酸性磷酸酶染色观察破骨细胞数量。结果冰茶栓可明显降低骨癌痛大鼠患肢X线评分(P0.01),改善肿瘤引起的骨损伤,降低骨组织破骨细胞数量(P0.01)。结论冰茶栓对W256细胞诱导的骨癌痛大鼠骨溶解具有较好的抑制作用。     

用超声方法检测血栓的物理实验研究

本文使用基于ＴＭＳ３２０Ｃ２５高速信号处理卡的双通道脉冲破经颅多普勒血流分析仪,建立起模拟血栓实验平台,从频域和时域两方面采集模拟血栓数据,并对血栓的特性及其检测方法进行研究,实验结果表明,从时域延迟和频谱特征变化两方面来检测血栓是一种应用前景的方法。     

腔静脉节段切除在肾癌伴下腔静脉癌栓中的应用 (附八例报告)

报告８例下腔静脉节段切除和系统性淋巴清扫肾癌根治术治疗右肾癌并腔静脉浸润性癌栓。４例无远处转移者中３例术后分别存活３６、４２和１７个月，１例２７个月后死于脑转移。４例有远处转移者术后２例分别存活１３和１４个月，１例有肝转移瘤者已存活６个月，１例膈上型癌栓者于术后８小时死于心肺功能衰竭。认为无远处转移者术后有较高的存活率，是积极外科治疗的指征；有单一远处转移者，手术治疗可延长存活时间。