12例脑动静脉畸形Onyx胶栓塞治疗的体会

目的探讨应用Onyx栓塞治疗脑动静脉畸形的应用价值。方法全麻下经股动脉穿刺插管,微导管超选择插管到达病变部位后,用Onyx栓塞治疗颅内动静脉畸形12例。结果12倒脑动静脉畸形患者,共行20次栓塞治疗,畸形血管团栓塞达80％以上者6例,其中3例完全栓塞,栓塞50％-80％者4例,栓塞50％以下者2例。发生颅内出血并发症1例,脑缺血I例。经过相应处理后好转。结论Onyx是治疗脑动静脉畸形较为理想的栓塞材料,血管内栓塞是脑动静动静脉畸形综合治疗中重要的组成部分。     

Onyx胶栓塞治疗脑动静脉畸形的价值

目的 探讨Onyx胶栓塞在治疗脑动静脉畸形中的价值.方法 采用Onyx-18胶栓塞治疗18例脑动静脉畸形患者,畸形血管团人小均在3cm以上,其中6cm及以上者7例,所有畸形血管团为多支血管供血.结果 畸形血管团在影像学上完全栓塞4例,畸形血管团栓塞〉80%4例,栓塞50%～80%6例,栓塞〈50%4例.并发生颅内出血1例.结论 Onyx胶是治疗脑动静脉畸形较为理想的栓塞材料.血管内栓塞是脑动静脉畸形综合治疗中重要的组成部分,但需注意掌握栓塞技巧,减少并发症的发生.     

Onyx胶栓塞治疗脑动静脉畸形应用价值

目的探讨Onyx胶在治疗脑动静脉畸形中的应用价值.方法采用Onyx-18胶栓塞治疗12例脑动静脉畸形患者,畸形血管团大小均在3 cm以上,其中6 cm及以上者3例,所有畸形血管团为多支血管供血.结果12例BAVM中,畸形血管团栓塞80%以上2例,栓塞50%～80%7例,栓塞50%以下3例.发生颅内出血并发症3例,其中1例死亡.结论Onyx胶是治疗脑动静脉畸形较为理想的栓塞材料,但需注意掌握栓塞技巧,减少并发症的发生.     

颅内动静脉畸形Onyx栓塞治疗并发脑出血临床分析

目的探讨颅内动静脉畸形血管内Onyx胶栓塞治疗并发颅内出血的原因及应对策略。方法回顾性分析我院介入放射科及神经外科2006年1月至2011年5月对36例因动静脉畸形行血管内Onyx胶栓塞治疗时术中或术后并发脑出血患者的临床资料。结果36例患者中5例出现颅内出血,发生率为13．89％;血管内栓塞术后立即出血3例（8.33％）,回病房后出血2例（5．56％）;其中2例（5．56％）行颅内血肿清除减压术,I例（2．28％）行单纯开颅减压术,2例（5．56％）行单纯保守治疗。术后随访1～1．5年,2例（5．56％）残留神经功能障碍,均为开颅患者,其中1例偏瘫,2例肢体麻木。结论颅内动静脉畸形血管内Onyx胶栓塞治疗并发颅内出血的机制较为复杂,其中术后畸形血管团及邻近脑实质血流动力学的急剧变化是重要原因;及时、正确地处理颅内出血,可减轻出血对脑实质的损害,降低致残率;术中术后持续低血压调控、术后持续镇静镇痛24h以上、分次栓塞、术前准确评估、术中精确操作等均可减少并发颅内出血的可能性。     

新型远距离注射Onyx方法栓塞颅内动静脉畸形:附26例报告

目的评价采用一种新型远距离注射Onyx方法栓塞颅内动静脉畸形(AVMs)的可行性、有效性及安全性。方法回顾性收集利用一种新型远距离注射Onyx方法治疗26例颅内AVMs患者的临床资料。通过压力传导系统,术者在介入观察控制室注射Onyx栓塞AVMs。结果 26例患者共行31次栓塞手术。畸形血管团体积平均缩小(61.48±26.85)%,完全栓塞3例。1例术中并发微导管破例致Onyx溢出,术后偏瘫。结论采用新型远距离注射方法Onyx栓塞治疗颅内AVMs安全可行,疗效显著,可节省术者体力,减少射线暴露,不增加新的相关并发症。     

脑动静脉畸形合并动脉瘤的血管内治疗

目的：探讨脑动静脉畸形（ Cerebral arteriovenous malformation,AVM）合并动脉瘤治疗策略、治疗方法。方法：经全脑数字减影血管造影（ Digital subtraction angiography DSA）检查确诊出血的10例患者,根据AVM血流动力学及动脉瘤特点,取不同栓塞策略,先栓塞动脉瘤后栓塞动静脉畸形。结果：畸形团内型5例,用Onyx胶、弹簧圈栓塞,单纯弹簧圈栓塞2例;与供血动脉相关型4例,与畸形团无关型1例,弹簧圈栓塞动脉瘤,再Onyx胶栓塞畸形血管。复查DSA,动脉瘤全部栓塞,AVM完全消失5例,3例栓塞80％,2例栓塞60％~80％,1例术后出现病变对例肢体轻度偏瘫。后期再次栓塞畸形血管团2例,行开颅切除畸形血管团1例,立体定向放射治疗2例。结论：动静脉畸形合并动脉瘤的血管内栓塞治疗可取得较好的效果,畸形团供血动脉瘤优先栓塞动脉瘤和载瘤动脉,畸形团内动脉瘤则以闭塞该部血流为主,如技术条件允许也尽量先栓塞带瘤血管巢。     

应用ONYX胶介入治疗脑动静脉畸形临床研究

目的:探讨Onyx胶栓塞治疗脑动静脉畸形的临床价值及技术要点。方法:回顾性分析应用Onyx胶介入治疗AVM患者25例,总结其疗效、并发症及预后情况,评价Onyx胶应用于AVM介入治疗中的临床价值并总结其技术要点。结果:25例完全栓塞者13例,80%以上栓塞4例,50%~80%以上栓塞8例。术中1例微导丝刺破血管出血,术后1例单侧肢体偏瘫,均经治疗后逐渐恢复。随访6~12个月,未发现畸形血管团再通。结论:应用Onyx胶栓塞治疗AVM具有较大的优越性和良好的疗效;在应用过程中应熟练掌握其性能、适应证和栓塞技巧,从而提高治愈率,减少和避免并发症的发生。     

液态栓塞剂Onyx治疗脑动静脉畸形

目的探讨并总结液态栓塞剂Onyx治疗脑动静脉畸形（AVM）的应用和经验。方法 2006年1月～2008年1月应用液态栓塞剂Onyx成功治疗脑AVM42例,畸形团的直径小于3cm13例,3～6cm21例,大于6cm8例。结果 6例完全消失,13例达90%以上,20例达80%～90%,3例80%以下。并发症：2例有术后头痛,1例有血管团对侧远端肢体麻木,1例微导管遗留体内。结论 Onyx治疗脑动静脉畸形有很好的疗效,并发症少。     

应用Onyx胶介入治疗脑动静脉畸形12例分析

目的:探讨新型液体栓塞剂Onyx胶在脑动静脉畸形血管内栓塞治疗中的应用价值及技术要点.方法:对采用Onyx胶栓塞治疗的12例脑动静脉畸形患者的临床资料进行分析.其中畸形血管团小于3 cm 6例,3～6 cm 4例,大于6 cm 2例,Spetzler-Martin分级Ⅱ级5例,Ⅲ级5例,Ⅳ级2例.结果:本组Onyx胶介入治疗的技术成功率为100%;6例完全栓塞,2例获90%栓塞,4例获75%栓塞.结论:Onyx胶是治疗脑动静脉畸形较为理想的栓塞材料;掌握栓塞技巧可以减少并发症的发生;Onyx胶介入治疗脑动静脉畸形的长期疗效有待随访结果的验证.     

Onyx栓塞治疗脑动静脉畸形的治疗探讨

目的:总结非黏附性栓塞材料乙醇聚合物的衍生物(Onyx)栓塞治疗脑动静脉畸形(cAVM)的临床效果,总结Onyx的应用经验.方法:对2011年10月至2012年12月14例cAVM患者进行Onyx栓塞治疗并随访.结果:其中完全栓塞5例,大部分栓塞4例,小部分栓塞5例,均未发生并发症.经2~6个月随访,其中1例4个月后再次出血死亡,2例完全栓塞病例3个月后复查数字减影血管造影(DSA)显示cAVM未见复发.结论:Onyx具有良好的可控性,是目前较理想的治疗脑动静脉畸形的栓塞材料,配合术者熟练的操作技巧,能完全栓塞cAVM.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.