Onyx栓塞治疗脑动静脉畸形

探讨0nyx栓塞治疗脑动静脉畸形的方法及疗效。方法采用seldinger技术经股动脉行全脑血管动脉造影．明确畸形血管团后,采用Marathon漂浮导管超选择进入畸形血管团内,使用Onyx对7例脑动静脉畸形进行栓塞。结果5例畸形血管团栓塞体积达50％～60％．50％以下2例,所有患者都进行了有效的栓塞．无1例出现并发症。结论Onyx是目前较理想的治疗脑动静脉畸形的栓塞材料．栓塞效果确切,但操作要谨慎,尽量减少并发症的发生。     

Percutaneous Transluminal Embolization with CoilsTreatment of Pulmonary Arteniovenous Malformations

The clinical values of coils emboliztion in the treatment of pulmonary arteriovenous malformations (PAVM) and related complications were investigated.eleven patients with PAVMs verified by pulmonary arterial angiography were treated by transcatheter coils embolization.Chest X-ray (11 cases),computer tomogaphy(7 cases) and/or magnetic resonance imaging (2 cases) were performed before embolization.Blood-gas analysis was done in 5 cases before and after embolization.the follow-up materials of 8 patients were collected to evaluate the effect of embolization with coils.The clinical manifestations included cerebral embolus,hemoptysis and decreased oxygenation in 9 patients and the remaining 2 has no symptoms.9/11 cases were found by chest X-ray and 8 were diagnosed definitely.7/7,2/2 cases were diagnosed by CT or MR and diagnosis was made in all cases.Embolization was performed in 29 vessels.Partial pressure of oxygen in arterial blood of 5 cases changed significantly before and after embolization.Slight complications occurred in 6 patients,such as low fever,chest pain,pleurisy.The follow-up results showed that 7 cases were cured effectively.No primary and secondary device migration,and no medical paradoxical embolization occurred.It was concluded that coils emboliztion is a well-established method for treating PAVMs.It is minimally invasive lung preserving treatment with hight efficiency and less complication.     

Multiple Salmonella enteritidis leg abscesses in a patient with systemic lupus erythematosus

We describe a 19 year old woman with systemic lupus erythematosus on corticosteroid therapy, who developed bilateral, multiple, gas-forming Salmonella enteritidis leg abscesses and osteomyelitis mimicking deep vein thrombosis. The infection was treated successfully by a combination of surgical drainage and intravenous ceftriaxone, followed by prolonged oral pefloxacin. This rare case of gas-producing S. enteritidis emphasizes the difficulty in diagnosing such complications in active systemic lupus erythematosus.     

Successful lobectomy in a patient of pulmonary arteriovenous malformation with hemoptysis

To the editor:Pulmonary arteriovenous malformation (PAVM) is abnormal communications between the pulmonary arteries and veins,and has been reported to be sporadic or to occur in association with hereditary hemorrhagic telangiectasia (HHT).1 The patients of PAVM may be asymptomatic,present with hypoxemia,paradoxical thromboembolism,or hemoptysis.Ference and coworkers 2 reported only 6 patients with hemoptysis in a review of 143 patients with PAVM.     

术中血管造影在脑动静脉畸形手术中的应用

目的:研究脑动静脉畸形(arteriovenous malfermation,AVMs)手术中脑血管造影的应用价值.方法:对41例AVMs患者在手术中进行脑血管造影.其中,男23例,女18例,年龄3～56岁[平均(34±8)岁].畸形血管团2～8 cm,其中巨大AVMs(直径≥6 cm)10例(24%).患者气管插管全麻后,经右侧股动脉插管,使导管到达手术涉及的颅内动脉.病灶处理完毕,进行血管造影.结果 :41例中有10例急性颅内出血患者手术前未造影,手术中经过血管造影证实为AVMs.39例(95%)经过造影证实病变处理满意,1例(2.4%)运动功能区AVMs有残留,1例(2.4%)后颅窝AVMs残存,此2例经过继续手术切除残余AVMs.本组无手术死亡,无造影相关并发症发生.术中血管造影需要时间25～130 min[平均(53±22) min].结论 :术中脑血管造影有助于医师及时发现残余AVMs,对小的AVMs进行定位,避免生理性供血动脉闭塞;立即修正技术缺陷,避免再次手术,降低手术后合并症发生率.     

Hereditary haemorrhagic telangiectasia with pulmonary arteriovenous malformations: a treatable cause of thromboembolic cerebral events

Hereditary haemorrhagic telangiectasia (HHT) or Osler-Weber-Rendu syndrome is associated with mucocutaneous telangiectases and iron deficiency anaemia caused by epistaxis or blood loss from the gastrointestinal tract. We describe a 41-year-old Chinese man who presented with amaurosis fugax secondary to emboli from pulmonary arteriovenous malformations associated with HHT. He was diagnosed with the disorder in adolescence but follow-up in the outpatient setting was incomplete. Early screening and regular follow-up of patients with HHT are important to minimise the risk of development of serious sequelae, such as thromboembolic strokes and cerebral abscesses. Appropriate management demands a knowledge of the risks and benefits of asymptomatic screening and treatment in the rapidly-evolving evidence base for this disease.     

Value of embolization of brain arteriovenous malformations with ethylene vinyl alcohol copolymer

Charcot-Marie-Tooth disease （CMT）, also known as hereditary motor and sensory neuropathies,comprises a genetically heterogeneous group of inherited peripheral neuropathies. Clinically it is characterized by progressive distal weakness, muscle atrophy, distal sensory loss and loss of deep tendon reflexes. Following electrophysiological criteria, CMT is divided into two main forms：     

Value of embolization of brain arteriovenous malformations with ethylene vinyl alcohol copolymer

To the Editor： We are interested in a recent article Embolization of brain arteriovenous malformations with ethylene vinyl alcohol copolymer： technical aspects written by GAO et al. Ethylene vinyl alcohol copolymer （Onyx） is a novel liquid embolic material used to cure brain arteriovenous malformations. They performed the embolization on 115 patients and they found that the complications of the treatment are scarce.     

介入栓塞术在肺动静脉瘘中的治疗价值

目的探讨介入栓塞术治疗肺动静脉痿的经验方法和疗效价值。方法回顾性分析经过影像学确诊的、并经过介入栓塞治疗后的4例肺动静脉瘘的患者,其中3例为单发囊状型,1例为多发囊状型,3例为女性,1例为男性．平均年龄为60岁。结果3例患者经介入栓塞治疗成功,平均血氧饱和度由术前的71％上升为术后的90％,患者术前的相应的临床症状及体征在术后逐渐消失;其中1例出院后1周出现脑梗塞。结论利用介入栓塞术可以有效治疗肺动静脉凄并且方法简单,较外科手术切除创伤小,安全系数高,是值得推广的一种有效的非手术治疗方法。     

16层螺旋CT血管成像在肺动脉畸形诊断中的应用

目的评价多层螺旋CT肺血管成像（MSCTPA）对肺动静脉畸形（PAVMs）的诊断价值。方法回顾性分析10例肺动静脉畸形的临床和MSCT表现。采用16层螺旋CT扫描仪,增强后分两期扫描,延迟时间分别为7～9s和21～23s。图像传后处理工作站进行血管重建,重建方法包括VR、MIP、MPR。结果CTA后处理血管重建可以显示供血动脉、畸形血管团、引流静脉,供血动脉的来源、引流静脉的去处也充分易显示。按病变形态与影像表现,肺动静脉畸形CT后处理表现分为三型：单纯型5例,复杂型2例,弥漫型3例。临床上单纯型均为体检发现,复杂型2例中1例体检发现,1例表现反复咯血;弥漫型3例患者均表现低氧血症。结论不同类型PAVMs,其临床表现、CT征象各异。MSCTPA可取代常规血管造影成为PAVMs的首选检查和诊断方法。     

Embolization of brain arteriovenous malformations with ethylene vinyl alcohol copolymer: technical aspects

Background Endovascular therapy plays an important role in the treatment of brain arteriovenous malformations （BAVMs）. Ethylene vinyl alcohol copolymer （Onyx） is a novel liquid embolic material. This study aimed to summarize our experience of using Onyx for embolization of BAVMs with the focus on embolization technique. Methods From September 2003 to November 2007, 115 patients （43 women and 72 men, with a mean age of 29 years） with BAVMs were endovascularly treated with Onyx in our department. The following features of all AVMs were evaluated prior to treatment： type of nidus and shunt, draining veins, and feeding arteries. A total of 196 endovascular procedures were performed. Results The course of endovascular treatment was completed in 88 patients. Additional sessions were planned in 27 patients. Of the 88 patients, total occlusion was obtained in 23 patients （26.1%）, near-total （〉80% of the original volume） occlusion was obtained in 35 patients （39.8%） and partial occlusion （〈80% of the original volume） was obtained in 30 patients （34.1%） using embolization as the sole therapeutic technique. Mean volume reduction was 72% （range 30%-100%） in 115 patients. Thirty four patients （38.6%, 34/88） underwent radiosurgical treatment. Additional embolization sessions were planned in 27 patients. Complications occurred in 19 patients （16.5%, 19/115）, leading to death in one patient （mortality 0.9%） and permanent disabling in 3 patients （morbidity 2.6%）. Conclusions Onyx was shown to be feasible and safe for embolization of BAVMs. Proper use of the Onyx injection technique largely improved the endovascular treatment of BAVMs. Large AVMs can be adequately reduced in size through the use of additional treatment.     

术中多普勒超声及超声血管造影在脑动静脉畸形手术中的应用

目的 探讨术中超声及超声血管造影在脑动静脉畸形(AVM)手术中的应用价值,论证供血动脉阻力指数(RI)变化与脑AVM是否全部切除的相关关系.方法 对82例脑AVM患者行微创神经外科手术,术中行多普勒超声检查,15例同时行超声血管造影检查,分析AVM声像特点,测量供血动脉砌,比较脑AVM切除前后数值的变化,判断是否存在畸形血管的残存.术中或术后行全脑血管造影(DSA)检查,判定脑AVM是否全部切除.结果 彩色多普勒超声可清晰地显示动静脉畸形的范围、边界.畸形血管团内含丰富的血流声像,双色红蓝混杂、方向各异的团状血流信号,优势供血动脉与引流静脉多可辨认.畸形血管切除前,供血动脉RI平均值为0.37±0.08;手术切除畸形血管团后,双色混杂血管团消失,砒平均值为0.63±0.09(P<0.05).8例病例清除脑内血肿后,畸形血管团的位置发生了明显移位,术中超声给予重新定位,确定手术探查方向.7例术中超声检查怀疑AVM残留,再次探查证实有畸形血管残存并予以全切除.结论 术中多普勒超声可实时进行脑AVM的定位、引导,术中超声血管造影可动态提供脑动静脉畸形的真实血供模式,结合RI使得脑动静脉畸形是否全切除的判定方法更加完善.     

An unusual inflammatory lesion of the jejunum in a patient with late onset immunoglobulin deficiency.

A 40-year-old male patient is reported in whom a grossly inflamed thickened 70-cm segment of jejunum complicated a ''late onset'' immunoglobulin deficiency state. The pathogenesis is unknown, but extensive occlusion of the vascular supply to the lesion may have contributed to its development.     

Multiple liver abscesses with isolation of streptococcus intermedius related to a pyogenic dental infection in an immuno-competent patient

Introduction

Streptococcus intermedius - a member of the Streptococcus anginosus group - is part of the normal microbial flora of the oral cavity. Despite being regarded as a harmless apathogenic commensal, Streptococcus intermedius has been described to cause abscesses in various locations of the body.

Case Presentation

We report the clinical case and course of treatment of a 18-year-old male patient presenting with multiple hepatic abscesses associated with an untreated pyogenic dental infection.

Conclusion

Streptococcus intermedius can cause liver abscesses emerging from dental infectious foci even in previously healthy patients without underlying innate or aquired immunodeficiency. The case illustrates the potential danger and underestimated risk associated with untreated dental infections.     

人脑动静脉畸形差异表达基因的筛选和研究

目的应用基因芯片技术分析人脑动静脉畸形的基因表达谱。方法收集4例脑动静脉畸形样本和4例难治性癫痫患者行颞叶切除后显微分离的脑血管对照样本,提取组织中的总RNA,分别标记荧光探针后与含有21522个基因的寡核苷酸芯片进行杂交,SAM软件筛选差异表达基因,最后应用在线生物分子功能注释系统分析其可能参与的分子信号通路。结果脑动静脉畸形样本中118个基因的表达存在显著性差异,表达上调的45个,下调的73个。丝裂原活化蛋白激酶（MARK）信号通路富集基因最多,差异基因MAPK3、RPS6KA1、DUSP14、DUSP2参与ERK1/ERK2MAPK信号传导。ITGA4基因表达显著上调,其平均表达水平是对照组的6.15倍。一些血管生成相关基因如血管内皮生长因子、血管生成素和Ephrin家族基因表达未见显著性差异。结论ERK1/ERK2MAPK信号通路可能参与脑动静脉畸形的血管生成和血管重构。ITGA4基因可能通过其产物介导纤维结合蛋白信号,促进血管内皮细胞的增殖,在脑动静脉畸形的血管生成中发挥重要作用。     

伽玛刀治疗脑动静脉畸形的疗效分析伽玛刀治疗脑动静脉畸形的疗效分析

目的 分析伽玛刀治疗脑动静脉畸形（AVM）的疗效和影响因素.方法 对行伽玛刀治疗的426例患者作3年以上随访.统计AVM闭塞率,分析Spetzler-Martin分级、病灶体积大小、放射剂量等因素对治疗效果、放射相关并发症的影响,以AVM完全闭塞率和并发症发生率为评价指标.结果 伽玛刀治疗组3年以上AVM完全闭塞率为83.8%.病灶体积、边缘剂量与闭塞率和并发症发生率显著相关.而Spetzler-Martin分级高低与闭塞率无明显相关性.结论 伽玛刀治疗脑AVM是一种安全有效的方法,特别是体积小、边缘剂量≥20Gy者疗效较好.对病灶体积较大者栓塞治疗后再行伽玛刀治疗或分次伽玛刀治疗能提高脑AVM的闭塞率,降低并发症发生率.