空气波预防腰椎术后下肢深静脉血栓形成的效果

目的观察使用空气波治疗仪对腰椎术后病人肢体肿胀、疼痛、腓肠肌压痛情况的影响，以及预防下肢深静脉血栓（DVT）形成的临床效果。方法200例腰椎术后病人随机分为治疗组、对照组各100例。治疗组在临床常规手术后第1天，双下肢应用POWER空气波治疗仪治疗；对照组在临床常规手术后应用低分子肝素钙或低分子右旋糖苷等药物治疗。比较两组治疗后双下肢静脉管壁光滑度，肢体肿胀、疼痛程度。结果治疗1周后两组病人肢体肿胀、肢体疼痛和腓肠肌压痛情况比较，差异均有显著性（x^2=8．7～17．5，P〈0．01）。治疗组治疗2周后肢体重度肿胀、疼痛及DVT的发生率明显低于对照组（x^2=8．4、31．2，P〈0．01）。结论空气波治疗仪能明显减少腰椎术后病人下肢DVT的发生率，对早期DVT有很好的预防作用。     

髂静脉受压综合征并下肢深静脉血栓形成的治疗探讨

目的 探讨手术取栓,经皮-大隐静脉置管溶栓联合支架置入治疗髂静脉受压综合征并急性左下肢深静脉血栓形成的临床效果。方法 对10例髂静脉受压综合征并急性左下肢深静脉血栓形成病人采用股静脉切开导管取栓,经皮、大隐静脉置管溶栓联合髂静脉支架置入治疗,静脉造影评价静脉通畅程度。10例均在术前行腹部和下肢增强CT检查明确诊断;7例增强CT见下腔静脉内血栓者行临时性下腔静脉滤器置入术后股静脉切开导管取栓,取栓术后经皮、大隐静脉置5 F导管鞘溶栓;3例直接行取栓溶栓治疗。10例均行球囊扩张及髂静脉支架置入术。结果 静脉造影示髂静脉再通率100%;术后患肢肿胀症状明显减轻或消失。结论 手术取栓、经皮经大隐静脉置管溶栓联合髂静脉支架置入是治疗髂静脉受压综合征并急性左下肢深静脉血栓形成的有效方法 之一;术前腹部和下肢增强CT检查可明确下腔静脉有无血栓形成从而为置入滤器提供证据。     

PARTIAL OCCLUSION OF THE PULMONARY AORTA AND INFERIOR VENA CAVA WITH THE METALLIC BAND. OBSERVATIONS ON CHANGES IN THE VESSEL WALL AND IN THE HEART

In dogs a constricting metallic band does not affect the integrity of the wall of the vena cava, whereas it leads to a rapid death of the wall of the aorta, and, as evidenced by a single instance studied, to a much slower death of the pulmonary artery. In the instance, just mentioned, constriction of the common pulmonary artery by an aluminum band for a period of 2½ years led to a right ventricular hypertrophy.     

深静脉血栓形成发病机理的探讨

应用14项反映血管壁、凝血、抗凝血和纤溶功能的指标,对112例DVT患者和120例正常人进行检测;并对8只家兔做颈总静脉血栓形成模型。结果表明,Fg:Ag和rWFAg的测定值明显高于正常对照值(P<0.001);AT-Ⅲ:Ag、pc:Ag和pc:a明显低于正常值(P<0.001);PLG:Ag、PLG:a和PL:a也降低(P<0.01,<0.001和<0.05)。由此可见,DVT的发病机理与血流郁滞、血液成分改变和血管壁损伤密切相关。     

SUPERIOR MESENTERIC VEIN OCCLUSION PRESENTING WITH A MASSIVE VASCULAR MALFORMATION OF THE COLON

Superior mesenteric vein occlusion is a rare condition which has protean clinical manifestations. It frequently occurs secondary to an underlying coagulation defect. We present the case of a young female who presented uniquely with a massive colonic vascular malformation and who had various predisposing factors, the most serious being a protein C deficiency.     

THE INCIDENCE OF DELAYED PNEUMOTHORAX AS A COMPLICATION OF SUBCLAVIAN VEIN CATHETERISATION

Delayed pneumothorax after subclavian vein catheterisation is a poorly recognised complication which can result hours or days after the catheter placement. We present our experience, during a three-year prospective study of 318 patients with 343 catheter placements in the subclavian vein. Seven patients (2.2%) developed pneumothorax immediately after the subclavian vein catheterisation. Two patients (0.6%) developed delayed asymptomatic pneumothorax that was recognised 48 and 72 hours after the catheter placement. The importance of recognition and treatment of this complication is obvious in patients with a central venous catheter, especially when they are to be operated under general anaesthesia and/or mechanical respiratory support.     

LYMPHANGIOMA PRESENTING AS A NECK MASS IN THE ADULT

Lymphangiomas are uncommon congenital lesions of the lymphatic system which usually present in childhood. We report a case of adult lymphangioma, localised in the neck, and discuss the presentation, diagnosis and management of this tumour.     

CONGENITAL DISLOCATION OF THE KNEE AS A CONSEQUENCE OF PERSISTENT AMNIOTIC FLUID LEAKAGE

SUMMARY A case congenital dislocation of both knees and dislocation of the left hip in an infant whose mother had a chronic amniotic fluid leakage after mid-trimester amniocentesis.     

UNRECOGNISED ARTERIAL INJURY OF THE FOREARM: A SECONDARY BLEED PRESENTING AS ACUTE COMPARTMENT SYNDROME

SUMMARY This case describes an arterial injury that remained unrecognised for 3 days, when a sudden secondary bleed caused acute compartment syndrome of the forearm. We have been unable to find another case of compartment syndrome presenting in this manner. The importance of thorough wound exploration is highlighted and the diagnosis and treatment of the syndrome discussed.     

FOLLICULAR CARCINOMA OF THYROID PRESENTING AS BACK PAIN LEADING TO A DELAY IN DIAGNOSIS

SUMMARY The case is described of a 53-year-old man presenting with right-sided low back and thigh pain. Non-urgent investigations showed a metastatic lesion in his right hemipelvis arising from a thyroid primary.     

THYROTOXICOSIS PRESENTING AS A LIFE THREATENING HYPOKALAEMIC PARALYSIS: INVESTIGATION OF THE Na/K PUMP IN ISOLATED LEUCOCYTES

A 37-year-old Chinese man presented with the rapid onset of profound muscle weakness, and a serum potassium of 1.7 mmol/l. The intravenous infusion of undiluted potassium chloride (2 mmol/ml) through a central venous catheter resulted in rapid recovery. Further investigation revealed thyrotoxicosis. He was treated with carbimazole and subsequently remained well. We assessed Na/K pump activity in isolated leucocytes taken from the patient and found an exaggerated response to adrenaline which ceased after he became euthyroid.     

CONGENITAL AFIBRINOGENAEMIA REPORT OF A CASE WITH A REVIEW OF THE LITERATURE

1. A case of congenital afibrinogenaemia, which is a rare causeof the haemorrhagic diathesis, is reported in a boy aged 11years.
2. Six other cases which have been recorded in the literaturearereviewed.
3. The principal clinical features of congenitalafibrinogenaemiaare its hereditary character, a high incidenceof consanguinityin the parents, the susceptibility of bothsexes, a total absenceof fibrinogen in the blood, completeincoagulability of theblood, a bleeding time which is usuallyprolonged, a great reductionof capillary resistance, a lowblood sedimentation rate, andintermittent thrombocytopenia.
4. Treatment of the severe haemorrhage is by intravenous transfusionwith whole blood or non-processed plasma.
5. Absence of fibrinogenis regarded as the principal cause ofthe haemorrhagic diathesisin congenital afibrinogenaemia, butdiminished capillary resistancemay be a. contributory factor.
6. Four cases of congenital hypofibrinogenaemiawhich have beenrecorded in the literature are also reviewed.
7. The principal distinctions between congenital afibrinogenaemiaand congenital hypofibrinogenaemia are discussed. The clottingtime shows the greatest divergence; no clotting occurs in afibrinogenaemia,whereas it is normal in hypofibrinogenaemia.
8. The aetiologyof both the congenital and acquired forms of afibrinogenaemiaand of hypofibrinogenaemia is discussed.

     

LIGATION OF THE SUPERIOR MESENTERIC VEIN: A CAUTIONARY TALE

SUMMARY Acute interruption of flow in the superior mesenteric vein can, in most instances, be tolerated. In the event of compromised venous collateral circulation, however, continuity of the main venous flow must be restored.     

A METHOD FOR REPEATEDLY SAMPLING THE BLOOD OF THE PORTAL VEIN IN HEALTHY ANIMALS

A method is described for repeatedly sampling the blood of the portal vein in healthy animals. The method has been employed in thirteen dogs with success in eight.