半张口位超声探查上颌动脉和脑膜中动脉

目的 观察半张口位超声探查上颌动脉（MXA）及脑膜中动脉（MMA）的价值。方法 前瞻性招募40名健康志愿者，分别行半张口位和闭口位经颞下窝彩色多普勒超声及头颈部CT血管造影（CTA），观察其所示双侧MXA及MMA，测量内径及血流动力学参数；以CTA为对照，评估超声探查MXA及MAA的价值。结果 半张口位超声对于MXA和MMA显示率分别为95.00%（76/80）和90.00%（72/80）；而闭口位超声显示率分别为75.00%（60/80）和60.00%（48/80）。半张口位与闭口位对于MXA和MMA的显示率差异均有统计学意义（P均<0.05）。MXA内径、收缩期峰值流速（PSV）及舒张末期流速（EDV）均显著大于MMA，而阻力指数（RI）及搏动指数（PI）小于MMA （P均<0.05）。半张口位及闭口位CTA中，MXA显示率均为100.00%（80/80），MMA显示率均为95.00%（76/80）；且半张口位超声与CTA对于MXA及和MMA的显示率差异均无统计学意义（P均>0.05）。CTA显示76条MXA走行于翼外肌下头浅面，4条MXA走行于翼外肌下头深面并与同侧MMA伴行直至MMA进入棘孔，且均未被半张口位超声所显示。结论 半张口位超声可用于探查MXA和MMA，显示率均与CTA相当。     

鼻内镜下泪前隐窝入路清除上颌窦内病变的观察

目的探讨经中鼻道开窗+泪前隐窝入路彻底清除上颌窦内病变的必要性。方法对30例54侧上颌窦病变,70°鼻内镜直视下经中鼻道开窗,查找并清除病变后,再行泪前隐窝入路,彻底清除上颌窦内残留病变。结果 (1)经中鼻道开窗可以窥及,但无法彻底清除上颌窦内病变9例14侧,约占总侧数的25.93%。而且经泪前隐窝入路窥及病变较之经中鼻道开窗所见更为广泛;(2)经中鼻道开窗清除上颌窦内病变,未窥及残留后,再行泪前隐窝入路,仍然发现18例32侧存有病变,约占总侧数的59.26%。结论 70°鼻内镜下经中鼻道开窗彻底清除上颌窦内病变,不仅困难,而且存在视觉死角,经泪前隐窝入路既能看清上颌窦内各壁,又能彻底清除上颌窦内病变。因此,在可能出现上颌窦病变残留时,有必要采用"中鼻道开窗+泪前隐窝入路"的双径路手术方式。     

超声测量240条舌动脉和颌外动脉内径及血流参数正常值

目的:超声测量舌动脉及颌外动脉内径及血流参数正常值。方法:研究对象为120例健康人,男女各半,以年龄分为3组:20~39岁,40~59岁和60岁以上,分别测量双侧240条舌动脉及颌外动脉的内径及血流参数正常值。结果:舌动脉内径D值及每分血流量F值男大于女,D值60岁以上年龄组小于其它两组(P<0.05);颌外动脉20~39岁组时间平均流速(TAV)、血流峰值(PS)及阻力指数(RI)测值大于40~59岁组,40~59岁组大于60岁以上年龄组(男性),而D及F值小于后两组(P<0.01)。结论:本文提供了超声测量舌动脉和颌外动脉正常值及其与年龄性别的关系。     

Histamine receptors in the isolated human middle meningeal artery. A comparison with cerebral and temporal arteries

The subtypes of histamine receptors mediating dilatation of human meningeal arteries have been tested in vitro, using "selective" antagonists, and compared with cerebral and temporal arteries previously examined. Dilatory responses were tested after preconstriction with prostaglandin F2 alpha. Both mepyramine and cimetidine caused a parallel shift to the right of the histamine concentration-response curve, suggesting the presence of both H1- and H2-receptors. Combined treatment with mepyramine and cimetidine caused further displacement of the concentration-response curve to the right. Schild analysis indicated pA2 values of 6.3 for cimetidine and 9.8 for mepyramine in situations of near complete blockade of either of the receptors. Both H1- and H2-receptors seem of importance for the histamine-induced dilatation in meningeal arteries and neither appear to dominate. The data considered in conjunction with our previous findings support the finding that experimental histamine-induced headache due to vasodilatation is intracranial of origin.     

Ultrasonographic assessment of arterial cross-sectional area in the thoracic outlet on postural maneuvers measured with power Doppler ultrasonography in both asymptomatic and symptomatic populations.

OBJECTIVE: The purpose of this study was to evaluate the feasibility and potential usefulness of power Doppler ultrasonography (PDU) in the assessment of changes in arterial cross-sectional area in the thoracic outlet during upper limb elevation. METHODS: Forty-four volunteers and 28 patients with a clinical diagnosis of arterial thoracic outlet syndrome were evaluated by B-mode imaging and PDU. Arterial cross-sectional area was assessed in the 3 compartments of the thoracic outlet with the arm alongside the body and at 90 degrees, 130 degrees, and 170 degrees of abduction. The percentage of arterial stenosis was calculated for each of these arm positions. Nineteen of the 28 patients were also assessed by magnetic resonance (MR) imaging. RESULTS: No significant arterial stenosis was shown in the interscalene triangle and in the retropectoralis minor space of the volunteers and patients. A significant difference (P < .01) in stenosis between volunteers and patients was seen for all degrees of abduction in the costoclavicular space. The 130 degrees hyperabduction maneuver appeared to be the most discriminating postural maneuver. Seven patients assessed with MR imaging did not have any arterial stenosis on MR images, whereas an appreciable degree of arterial stenosis was shown with ultrasonography. CONCLUSIONS: Arterial compression inside the thoracic outlet can be detected and quantified with B-mode imaging in association with PDU.     

Reactions of the middle meningeal artery of the cat to neural and humoral stimulation

The physiology and pharmacology of the middle meningeal artery was investigated in cats in order to determine whether this artery was subject to normal neural and humoral control mechanisms. Carotid and middle meningeal arterial blood flows and resistances were measured in 16 cats anaesthetized with chloralose. The cervical sympathetic nerves were stimulated electrically. Stimulation of the cervical sympathetic nerves pre-ganglionically reduced blood flow in the middle meningeal artery by producing vasoconstriction in its resistance bed. The vasoconstriction was mediated via catecholamine-containing nerves, as it was abolished by prior intravenous administration of bretylium. Intravenous injections of noradrenaline or adrenaline also produced vasoconstriction in the middle meningeal arterial bed. 5-Hydroxytryptamine (5HT), on the other hand, produced a dilatation in the middle meningeal artery. We conclude that neurally or humorally released catecholamines can provide a plausible mechanism for vasoconstriction in the middle meningeal artery. The dilator effect of 5HT contrasts with the constrictor effect of the 5HT₁-like receptor agonist sumatriptan and suggests a complex 5HT receptor pharmacology for the artery.     

6例上颌窦肿瘤伴颞下窝侵犯的围手术期护理

总结了6例上颔窦肿瘤伴颞下窝侵犯患者的围手术期护理.护理重点包括密切观察生命体征、呼吸道通畅程度及眼部和耳郝功能状态,观察和记录出血,预防感染,给予克分的营养支持,及时进行术后功能锻炼.患者3周后出院,出院时视力良好,视野清晰,听力正常,未出现相应的呼吸道梗阻、眶内感染及张口受限等严重并发症.     

Reliability of intrarenal Doppler sonographic parameters of renal artery stenosis

PURPOSE: The goal of this study was to retrospectively evaluate false-negative results of Doppler sonography in the diagnosis of renal artery stenosis (RAS) using intrarenal criteria. METHODS: We reviewed the clinical data and Doppler sonographic data for all patients in whom a diagnosis of RAS had been confirmed angiographically between November 1992 and January 2001. Mean intrarenal acceleration and acceleration time values-data obtained directly from color Doppler sonography-and findings of angiographic examination of the kidneys and stenotic renal arteries were evaluated. RESULTS: During the study period, 55 cases of RAS had been angiographically confirmed in 46 patients (25 male and 21 female; mean age, 50 +/- 19 years [+/- standard deviation]). Intrarenal arterial acceleration, acceleration time values, or both were abnormal in 42 kidneys (76%) (group A) and normal in 13 kidneys (24%) (group B). The mean age +/- standard deviation was significantly higher for patients in group B (60 +/- 12 years) than for those in group A (47 +/- 20 years) (p > 0.05). In group B, most of the stenotic lesions were atherosclerotic, and in all kidneys but 1, the lesions were located at the renal ostium or the proximal half of the artery. CONCLUSIONS: Isolated use of intrarenal Doppler sonographic criteria for RAS may lead to an unacceptably high incidence of false-negative results in the diagnosis of this condition, especially in elderly patients.     

Usefulness of interventional embolization of the middle meningeal artery for recurrent chronic subdural hematoma: Five cases and a review of the literature

Purpose

Although several strategies against recurrent chronic subdural hematoma (CSDH) have been proposed, no consensus has been established. Recently, middle meningeal artery (MMA) embolization has been proposed as radical treatment for recurrent CSDH. We wanted to estimate the usefulness of MMA embolization for recurrent CSDH.

Methods

From February 2012 to June 2013, 110 patients with CSDH underwent single burr-hole surgery with irrigation and drainage. Among these patients, 13 showed recurrent hematoma formation and were retreated surgically. Furthermore, repeated recurrence of CSDH was observed in six patients. Five of these six patients underwent middle meningeal artery (MMA) embolization with polyvinyl alcohol particles. All five patients with interventional treatment were observed for four to 60 weeks.

Results

No more recurrence of CSDH was observed in any of the patients. During the follow-up period, no patients suffered from any side effects or complications from the interventional treatment.

Conclusion

MMA embolization with careful attention paid to the procedure might be a treatment of choice for recurrent CSDH.     

脐动脉血流变化对估计脐带绕颈胎儿预后的价值

目的:探讨脐动脉血流变化对估计脐带绕颈胎儿预后的价值。方法:选取2003年1~9月足月妊娠妇女46例,其中观察组34例,均为脐带绕颈1周并经阴道分娩。结合胎儿预后将观察组分为胎窘组(10例)和正常组(24例)。对照组12例,为随机选择的同期正常妊娠并顺产的妇女。应用彩色多普勒超声技术对全部孕妇于临产前和活跃早期检测胎儿脐动脉阻力指标——收缩期峰值流速/舒张末期流速(S/D)、阻力指数(RI)和搏动指数(PI)。结果:①临产前胎儿UA血流S?蛐D、RI、PI值,胎窘组、正常组分别与对照组比较,差异均无显著性(P>0.05)。②活跃早期宫缩期和间歇期,胎儿UA血流S?蛐D、RI、PI值,胎窘组、正常组分别与对照组比较,差异均无显著性(P>0.05)。结论:产前及活跃早期监测脐动脉血流变化不是预测脐带绕颈胎儿不良预后的理想方法。     

彩色多普勒超声对椎动脉走行变异诊断价值的研究

目的：研究椎动脉走行变异患者椎动脉血流动力学的超声诊断价值。方法：用彩色多普勒对颈椎病患者进行检测，从1161例颈椎病中筛选出113例椎动脉走行变异患者，对变异侧内径和血流参数与对照组进行统计学比较。结果：椎动脉走行变异其变异侧椎动脉超声表现为：管径较窄，PI和RI较高，流速较低。结论：彩色多普勒超声对椎动脉走行变异是一种理想的无创性诊断方法。     

经鼻内镜鼻腔-鼻窦-翼腭窝-颞下窝手术入路的应用解剖学研究

目的通过对鼻腔-鼻窦-翼腭窝(pterygomaxillaryfossa,PMF)-颞下窝(infratemporalfossa,ITF)手术入路的相关结构进行解剖,为手术入路提供解剖学基础。方法对6例12侧成人尸头标本按中线锯开后进行解剖,并完全模拟该手术入路,对相关解剖标志进行了观察、拍摄和测量。结果翼腭窝-颞下窝区结构复杂,有重要的神经和血管经过。圆孔外口距正中矢状面距离为(19.18±1.48)mm,与后鼻孔上缘的距离为(19.81±1.52)mm,距鼻小柱根部为(77.31±5.13)mm。卵圆孔到鼻小柱根部为(86.40±3.76)mm。结论经鼻内镜鼻腔-鼻窦-翼腭窝-颞下窝手术入路能够简单和迅速地到达翼腭窝和颞下窝,可较好地显露翼腭窝及部分颞下窝区的结构。经鼻内镜入路进入PMF时术野的深度限制为70mm左右,注意保护位于蝶窦外侧壁的翼管神经、上颌神经及颈内动脉(internalcarotidartery,ICA),进入ITF时,术野的深度限制为80mm左右。     

Upfront middle meningeal artery embolization for treatment of chronic subdural hematomas in patients with or without midline shift

ObjectivesThere is limited data on upfront middle meningeal artery (MMA) embolization in the context of significant midline shift (MLS) (greater than 5mm) for the treatment of chronic subdural hematomas (cSDH). This study reports the temporal changes following MMA embolization as an upfront treatment of cSDH in patients with or without MLS and either mild, no symptoms or mild and stable neurological deficits.MethodsA retrospective series of patients with a cSDH from a single institution in the United States between 2018-2020 was conducted. Eligible patients were treated with upfront MMA embolization.Results27 upfront MMA embolization procedures in 23 patients were included. Twelve patients had MLS of 5 millimeters or more (52%). The median maximal thickness at diagnosis was 18 mm [11-22]. The mean distance of MLS was 5 mm ±4. There were no procedural complications. The overall rescue surgery rate was 15%. A single rescue surgery secondary to an increase in hematoma thickness was required (4%). The temporal changes for both hematoma and MLS showed gradual improvement between 2 weeks and 4 weeks post-procedure. The average time-to-resolution of MLS was 46 days in patients with less than 5 mm MLS and 51 days in those with 5 mm or more.ConclusionUpfront MMA embolization for cSDH with a thickness up to 25 mm provides adequate symptom relief, stabilization and/or progressive resorption of the cSDH during follow-up in carefully selected asymptomatic or mildly symptomatic patients even in the presence of a MLS greater than 5 mm.     

Agenesis of the internal carotid artery: Color Doppler,CT, and MR angiography findings

Agenesis of the internal carotid artery (ICA) is a rare finding that can lead to the false diagnosis of an ICA occlusion. We present the case of a young woman with agenesis of the left ICA. Diagnosis was made noninvasively by color Doppler imaging (CDI) in combination with high-resolution CT of the base of the skull. Magnetic resonance angiography confirmed the diagnosis. CDI in combination with CT of the base of the skull allows the diagnosis of ICA agenesis without the use of invasive procedures. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26:213–216, 1998.     

Pseudoaneurysm of the dorsalis pedis artery: color Doppler sonographic and angiographic findings

Pseudoaneurysm of the dorsalis pedis artery is an uncommon condition that is usually caused by a traumatic injury or an iatrogenic intervention. The patient usually complains of an enlarging painless, pulsatile mass. A tentative diagnosis may be made by palpation of the pulsatile mass and detection of an associated systolic bruit. Color Doppler sonographic and arteriographic examinations can be used to confirm the diagnosis. We report the case of a 17-year-old patient with a posttraumatic pseudoaneurysm of the dorsalis pedis artery. Sonographic examinations revealed pulsatile flow into and out of a cystic structure surrounded by a thick hypoechoic wall and a "to-and-fro" pattern in the neck of the vascular mass; these findings were consistent with the diagnosis of a pseudoaneurysm. Angiography confirmed the diagnosis. The patient was treated with ligation of the artery and resection of the pseudoaneurysm. He recovered well after surgery and remained free of symptoms 3 months postoperatively. We believe that color Doppler sonography should be the procedure of choice for use in diagnosing pseudoaneurysms; arteriography can then be used to evaluate the alternative blood supply before surgery is undertaken.     

Comparison of the vasodilator responses of isolated human and rat middle meningeal arteries to migraine related compounds

Background

Migraine attacks occur spontaneously in those who suffer from the condition, but migraine-like attacks can also be induced artificially by a number of substances. Previously published evidence makes the meninges a likely source of migraine related pain. This article investigates the effect of several vasodilators on meningeal arteries in order to find a connection between the effect of a substance on a meningeal vessel and its ability to artificially induce migraine.

Methods

A myograph setup was used to test the vasodilator properties of the substances acetylcholine (ACh), sodium nitroprusside (SNP), sildenafil, prostaglandin E₂ (PGE₂), pituitary adenylate cyclase activating peptide-38 (PACAP-38), calcitonin gene-related peptide (CGRP) and NaCl buffer on meningeal arteries from human and rat. An unpaired t-test was used to statistically compare the mean E_max(%) at the highest concentration of each substance to the E_max(%) of NaCl buffer.

Results

In the human experiments, all substances except PACAP-38 had an E_max (%) higher than the NaCl buffer, but the difference was only significant for SNP and CGRP. For the human samples, clinically tested antimigraine compounds (sumatriptan, telcagepant) were applied to the isolated arteries, and both induced a significant decrease of the effect of exogenously administrated CGRP. In experiments on rat middle meningeal arteries, pre-contracted with PGF_2α, similar tendencies were seen. When the pre-contraction was switched to K⁺ in a separate series of experiments, CGRP and sildenafil significantly relaxed the arteries.

Conclusions

Still no definite answer can be given as to why pain is experienced during an attack of migraine. No clear correlation was found between the efficacy of a substance as a meningeal artery vasodilator in human and the ability to artificially induce migraine or the mechanism of action. Vasodilatation could be an essential trigger, but only in conjunction with other unknown factors. The vasculature of the meninges likely contributes to the propagation of the migrainal cascade of symptoms, but more research is needed before any conclusions can be drawn about the nature of this contribution.     

直肠癌的腔内高频彩超声像图表现

目的 探讨直肠癌的腔内高频彩超声像图特点。方法 经直肠高频彩起检查25例直肠癌并与手术病理结果进行对照分析;测定20例正常人直肠粘膜层动脉流速曲线。结果 直肠癌直肠粘膜层回声连续性中断,呈低回声肿块,边界不清,无包膜,可伴有微钙化。腔内高频超声可检测直肠癌肠壁内外浸润程度。恶性肿块内部动脉血流丰富,BIO.71±0.08,正常直肠粘膜层RI0.83±0.08(P<0.01)。结论 直肠癌的二维声像图表现,如肿块的边界,内部回声,钙化均有一定特点;腔内高频超声对直肠癌浸润度检测有极高的临床价值。     

Color Doppler sonography of orbital and vertebral arteries in migraineurs without aura

PURPOSE: The objective of this study was to investigate whether the retrobulbar hemodynamics in the ophthalmic (OA), posterior ciliary (PCA), central retinal (CRA), and vertebral (VA) arteries are affected in migraineurs without aura. METHODS: The eyes of migraineurs without aura and those of healthy control subjects were evaluated during both headache and headache-free periods. Retrobulbar and vertebral blood flow velocities in the OA, PCA, CRA, and the extracranial part of the VA were measured bilaterally using color Doppler sonography. The peak systolic and end-diastolic flow velocities and the pulsatility (PI) and resistance (RI) indices were determined for all arteries. RESULTS: In total, we enrolled 30 migraineurs and 31 healthy control subjects. Statistically significant differences between headache-free migraineurs and control subjects were observed in the PI and RI of both right and left PCAs and in the RI of both right and left CRAs. The PI and RI of the left VA of the migraineurs were significantly lower during both headache and headache-free periods than were those of the control subjects. Among the migraineurs, the peak systolic and end-diastolic velocities of the left VA were increased during headache periods relative to those found during the headache-free periods. CONCLUSIONS: The retrobulbar circulation and flow hemodynamics in the left VA may be altered in both headache and headache-free periods in migraineurs without aura. The differences found between migraineurs and control subjects may implicate autonomic dysfunction in migraineurs.     

血流剪切率与颈动脉粥样硬化斑块的关系

目的:应用超声多普勒技术探讨血流剪切率在颈动脉粥样硬化斑块形成中的作用。方法:将78例高血压患者按颈动脉内是否存在粥样斑块分为斑块组和无斑块组。生化测定TC、TG、HDL、LDL、BS水平,计算最大剪切率。结果:斑块组患者的年龄、颈动脉内径明显高于无斑块组,最大剪切率低于无斑块组。结论:最大剪切率减低及颈动脉内径增宽是颈动脉粥样斑块形成的重要危险因素。