锁骨下动脉、腋动脉、肱动脉血管广泛血栓形成1例

1病例资料患者,男,44岁。右上肢肿胀刺痛1个月加重伴手指麻木发凉5d,于2007年12月13日18：00急诊入院。患者自述于1个月前出现右侧手指指尖麻木,近5d右上肢麻木、胀痛明显加重,自测不到脉搏,右上肢皮肤苍白,皮温低,呈持续性,伴胸闷、气短、大汗。心电图：窦性心率（正常心电图）;右上肢血管超声：右侧锁骨下动脉下段、腋动脉、肱动脉血管闭塞（完全性血栓形成）;血压16／10kPa;血糖正常。以“左上肢动脉栓塞”收住入院。患者既往有小儿麻痹症病史,右下肢发育短小、无力,长期扶双拐行走;常伴有右上肢苍白,皮肤发凉,肱动脉、桡动脉、尺动脉脉搏测不到。     

Pharmacological response of internal mammary artery and gastroepiploic artery

Pharmacological response of coronary artery bypass conduit is of great importance. This study was designed to clarify the contractile properties of internal mammary artery and gastroepiploic artery obtained from coronary revascularization. The response to ergonovine, serotonin, and phenylephrine was examined by isometric contraction recording apparatus. The concentration-response relation of both internal mammary artery and gastroepiploic artery to ergonovine, serotonin, and phenylephrine showed similar sigmoid curves. There were no significant differences in developed tension between internal mammary artery and gastroepiploic artery at any concentration for any agent. There were no significant differences in the 50% effective dose value for any agent between internal mammary artery and gastroepiploic artery. Internal mammary artery and gastroepiploic artery are reported to be similar in terms of size, flow capacity, and freedom from atherosclerosis. This study shows their equivalence from a pharmacological viewpoint.     

Reconstruction of the hepatic artery using the gastroduodenal artery

Although injury of the hepatic artery is not common during the performance of biliary and pancreatic resections, the hepatic artery if involved by tumor extension can be injured during its dissection.Several methods for reconstruction of the hepatic artery have been described and although each technique is applicable in a specific situation, autologous tissue conduits are preferable in contaminated operative fields. We report here another transposition technique to reconstruct the proper hepatic artery using the gastroduodenal artery, which may provide a local autologous artery for repair of hepatic artery damage during pancreaticoduodenectomy.     

Coronary artery spasm following coronary artery surgery

Coronary artery spasm during the early postoperative period following cardiopulmonary bypass for coronary artery surgery can be an unrecognized cause of sudden, severe cardiopulmonary collapse. The literature regarding perioperative coronary artery spasm is reviewed, and methods of prevention, diagnosis, and treatment are suggested. Preoperative angina at rest appears to be an important identifying factor in patients who experience postoperative coronary spasm. Anatomically, the presence of a relatively normal, dominant right coronary may also indicate increased risk for early post-coronary bypass spasm. Acute hypotension is often the first sign of coronary artery spasm, and conventional treatment methods may only worsen the vasospastic reaction. Peripheral intravenous nitroglycerin infusion has often been unsuccessful treatment while intragraft or intracoronary nitroglycerin injection or administration of calcium channel-blocking drugs, or both, has proven to be effective in reversing the coronary artery spasm and ventricular dysfunction. Reluctance to use vasodilating agents must be overcome, even in the face of hypotension, when evidence of spasm is present.     

Internal mammary artery to pulmonary artery fistula

A rare case of arteriovenous fistula between an internal mammary artery and a pulmonary artery is presented. The clinical history of recurrent bronchitis and dyspnoea during exercise, the presence of right parasternal murmur with normal heart size and normal blood gases justified the execution of an arteriovenous thoracic angiography which revealed the presence of a cirsoid aneurysm supplied by the internal and external mammary arteries. Diagnostic investigation and surgical indication in patients with the rare fistulous communication between the internal mammary artery and the systemic or pulmonary circulation are analysed.     

Iliac artery pseudoaneurysm following umbilical artery catheterization

We report a case of a large iliac artery pseudoaneurysm in a newborn infant following umbilical artery catheterization. The aneurysm was excised and a primary repair was performed with limb salvage and reestablishment of normal blood flow to the foot. While these aneurysms are rare, prompt surgical repair should be performed as soon as the diagnosis is made because the associated mortality is high.     

Coronary artery spasm following coronary artery revascularization

Coronary artery spasm is a well-documented phenomenon in patients undergoing medial treatment. We describe coronary artery spasm occurring in the immediate postoperative period following coronary artery bypass operation. The spasm occurred in a vessel that was not operated on and that had no apparent lesion. The diagnosis of spasm was made by coronary angiography immediately after operation. Complications associated with this spasm are discussed. Emphasis is placed on early postoperative angiography for patients whose condition is inexplicably unstable after operation.     

Superficial temporal artery to superior cerebellar artery anastomosis for distal basilar artery stenosis

The conceptualization, rationale and surgical technique involved with a superficial temporal artery to superior cerebellar artery anastomosis for midbrain ischemia in a patient with symptomatic mid-basilar artery stenosis is described and discussed.     

胃十二指肠－右肾动脉旁路转流术治疗肾动脉狭窄

作者采用自体大隐静脉间置移植，作胃十二指肠动脉旁路转流术，治疗肾动脉狭窄、肾血管性高血压１例。术后随访１年，取得良好控制高血压疗效。作者认为，间置自体大隐静脉的内径不应小于０．４ｃｍ，吻合后移植大隐静脉段无张力。防止受压、成角、扭曲以及缩短缺血时间，是保护肾脏功能和使手术取得成功的关键。     

肺动脉高压幼犬肺动脉压力与肺动脉结构的关系

目的 探讨肺动脉高压（ＰＨ）时肺动脉压力（ＰＡＰ）与结构的关系。方法 实验幼犬１５条,分２组：分流组（ｎ＝１２）,正常对照组（ｎ＝３）。分流术后９０ｄ两组行血流动力学检测后,放血处死,肺组织切片行病理学检测。结果 （１）分流组左下肺动脉压（ＰＬＬＰＡ）由１．３６ｋＰａ（１ｋＰａ＝０．７５ｍｍＨｇ）升至１１．１３ｋＰａ,左下肺血管阻力（ＬＬＰＶＲ）由５．６５Ｗｏｏｄ’ｓ单位升至１４．３１Ｗｏｏｄ’ｓ     

Use of the gastroduodenal artery in right renal artery revascularization

Of 15 patients having revascularization of the right renal artery with the use of the hepatic circulation from May 1984 through March 1987 at the Massachusetts General Hospital, eight patients had this accomplished with end-to-end anastomosis of the gastroduodenal artery and right renal artery. Operative indications were acute azotemic renal failure (three patients), poorly controlled renovascular hypertension (four patients), and staged repair of bilateral renal artery disease (one patient). All revascularizations were successful in restoring renal function or rendering hypertension manageable and were assessed by means of renal flow scans, celiac angiography, or return of function in those patients with a solitary, functioning kidney. All patients survived the operation with one late death caused by myocardial infarction after abdominal aortic aneurysm repair. The gastroduodenal artery may be used as the source for arterial inflow in revascularization of the right renal artery by end-to-end anastomosis in approximately 50% of instances, conferring the advantage of the use of only one anastomosis and obviating the long-term possibility of vein graft failure.     

Inadvertent placement of pulmonary artery catheter into right carotid artery

PURPOSE: To report a case of misplacement of a pulmonary artery catheter (PAC) into the carotid artery after open heart surgery. CLINICAL FEATURES: A 20-mo-old boy underwent open heart surgery (VSD repair). On the first day postoperatively, he had severe pulmonary hypertension and a PAC was inserted via the left internal jugular approach without complication. Two hours later, chest radiography showed the PAC in the right internal carotid artery which it had reached via the right and left ventricles and aorta. The PAC was withdrawn and a new PAC was inserted and its position was confirmed by chest radiography. Two years later echocardiography failed to demonstrate the second VSD or a residual leak through the patch although a PAC could be passed from the right ventricle to the left ventricle and subsequently into the aorta and right carotid artery. CONCLUSION: Correct placement of a PAC should be confirmed by chest radiography or other techniques to prevent complication.