脊髓疾病的诊断与治疗——脊髓血管病诊断

血液供应脊髓的血供应有特殊性,来源于椎动脉、颈升动脉、肋颈干、肋间动脉、腰功脉背支、髂腰动脉和外侧髂动脉。这些血管形成两条供血的通路—脊髓前动脉、脊髓后动脉(双)。脊髓前动脉上起自椎动脉的脊髓前支,在前纵裂内沿脊髓长轴延伸;脊髓后动脉是椎动脉的脊髓后支的延续,在后外侧沟内沿脊髓长轴走行,脊髓前、后动脉都接受来自根动脉的附加血液,脊髓前后动脉之间形成环形分支,互相广泛吻合,构成一个     

输卵管绝育术后的卵巢功能

近30年来输卵管绝育术在世界范围内急剧增加,到1980年全世界约有一亿以上的妇女进行了绝育。因而对手术的方式要求既简便、安全又不影响卵巢功能(以下简称卵功),以有利于复孕术后的妊娠。本文就有关输卵管绝育术后卵功是否有改变,以及其改变的性质、程度等问题综述如下。输卵管、卵巢血液循环及神经分布输卵管的血液供应来自卵巢动脉分支与子宫动脉分支,它们在输卵管系膜内形成“弓”形血管网。此网互相交通,故血液循环很丰富。卵巢血管呈螺旋状分布于全卵巢内,排卵前卵泡的泡膜区有大量新的血管形成。近年来的研究强调了卵泡血管对排卵的     

子宫动脉或髂内动脉前干分支栓塞术治疗产后出血的临床观察

目的:探讨应用子宫动脉或髂内动脉前干分支栓塞术治疗产后出血的临床效果及近远期不良反应。方法:对11例产后出血患者和1例产前胎儿畸形、前置胎盘并植入的晚期妊娠患者采用seldinger技术分别行双侧子宫动脉或髂内动脉前干插管,用明胶海绵颗粒栓塞血管。其中11例栓塞子宫动脉,1例除栓塞子宫动脉外还栓塞髂内动脉前干的其他分支如阴道动脉。结果:12例患者全部成功止血,3例栓塞后再次成功清宫清除残留胎盘,1例穿刺部位股动脉局部血栓形成,经治疗痊愈。10例产后月经正常,2例因胎盘粘连刮宫后宫腔粘连,经治疗后1例恢复正常,1例月经过少。结论:子宫或髂内动脉前干分支栓塞术能够迅速、有效地制止产后出血,成功率高,不影响正常月经,无近远期严重副作用,适用于多种包括严重产后出血的救治。     

迷走右锁骨下动脉一例

患者男,77岁.反复头晕发作3 d.3 d前无明显诱因出现头晕、昏沉感,伴恶心,无呕吐,双下肢乏力,走路不稳.临床诊断为椎-基底动脉缺血发作;脑梗死后遗症.多层螺旋CT增强扫描后容积再现重建示主动脉有三支主要分支(图1),且由近心端至远心端依次为:右左颈总动脉共干、左锁骨下动脉、右锁骨下动脉.轴位像示右锁骨下动脉自主动脉弓左后部发出后,经气管、食管后方和椎体前方走行至右侧(图2),从而与气管前方走行的右颈总动脉构成血管环,将气管、食管包绕.诊断为迷走右锁骨下动脉.     

迷走右锁骨下动脉一例

患者男,77岁.反复头晕发作3 d.3 d前无明显诱因出现头晕、昏沉感,伴恶心,无呕吐,双下肢乏力,走路不稳.临床诊断为椎-基底动脉缺血发作;脑梗死后遗症.多层螺旋CT增强扫描后容积再现重建示主动脉有三支主要分支(图1),且由近心端至远心端依次为:右左颈总动脉共干、左锁骨下动脉、右锁骨下动脉.轴位像示右锁骨下动脉自主动脉弓左后部发出后,经气管、食管后方和椎体前方走行至右侧(图2),从而与气管前方走行的右颈总动脉构成血管环,将气管、食管包绕.诊断为迷走右锁骨下动脉.     

胫骨血供的临床解剖研究

[目的]进一步对胫骨血运进行更为详尽的解剖学研究,以减少手术对胫骨血运的破坏.[方法]采集新鲜成人下肢标本16例(左、右各半),用预先配制的红色乳胶经股动脉加压灌注,10%甲醛固定;解剖时取下肢前正中切口,紧贴皮下游离剥除皮肤;显露隐神经、大隐静脉、小隐静脉,予以旁置或切断;自胫骨前面上端暴露出胫骨前方血管分支;由胫骨两侧贴骨与肌肉之间的间隙剥离暴露胫前、后动脉及其分支,予测量标记.[结果]胫骨血供由骨髓干髓血管系统、滋养血管系统,以及骨膜血管系统等3部分构成.血供特点:(1)胫骨两端血供明显较骨干部丰富;(2)胫骨骨干部动脉供应主要依赖于滋养动脉系统,其次为发自胫前、后动脉的骨膜支,供应骨膜及骨皮质外层的血运;(3)胫骨骨干外侧面较胫骨前内侧面及后面血供丰富:胫骨外侧面有较多(5～7支)的自接骨膜支来自胫前动脉;胫骨骨干后面骨膜支较少(2～4支),直接或间接来自胫后动脉;胫骨内侧面紧邻皮下,由来自胫前、后动脉的分支末梢分布至骨膜形成骨膜血管网,相对而言血供最差.骨膜血管体系对胫骨血运构成重要补充,尤其在胫骨骨折滋养动脉遭到破坏时更为重要.[结论]胫骨血液供应有3个来源:骨髓干髓血管系统;滋养动脉系统;骨膜血管系统.胫骨血供特点:胫骨两端的骨髓干髓血管系统发达;胫骨骨干外侧面骨膜支丰富.     

子宫动脉灌注化疗加栓塞术治疗子宫瘢痕部位妊娠的应用研究

目的:探讨子宫动脉栓塞术在治疗子宫瘢痕部位妊娠中的作用。方法:将该院1999年5月～2009年5月收治的剖宫产瘢痕部位妊娠采用子宫动脉灌注化疗加栓塞术的7例患者的临床资料进行分析。结果:双侧子宫动脉化疗灌注加栓塞术能快速止血,术后血β-HCG下降满意,结局良好,无1例发生大流血或切除子宫。结论:子宫动脉灌注化疗加栓塞术是保守治疗子宫瘢痕部位妊娠的一种安全有效的方法。     

迷走右锁骨下动脉一例

患者 男,77岁。反复头晕发作3d。3d前无明显诱因出现头晕、昏沉感,伴恶心,无呕吐,双下肢乏力,走路不稳。临床诊断为椎．基底动脉缺血发作;脑梗死后遗症。多层螺旋CT增强扫描后容积再现重建示主动脉有三支主要分支（图1）,且由近心端至远心端依次为：右左颈总动脉共干、左锁骨下动脉、右锁骨下动脉。轴位像示右锁骨下动脉自主动脉弓左后部发出后,经气管、食管后方和椎体前方走行至右侧（图2）,从而与气管前方走行的右颈总动脉构成血管环,将气管、食管包绕。诊断为迷走右锁骨下动脉。     

名词解释什么是微循环?

微动脉、毛细血管网和微静脉之间的血液循环。微循环的结构有简有繁,典型的微循环由微动脉、后微动脉、毛细血管前括约肌、真毛细血管、通血毛细血管、动静脉吻合支和微静脉组成。这些血管的口径都很小,最粗的也在500微米以下,只能在显微镜下看到。微循环结构中的毛细血管广泛分布于组织细胞周围形成网络。它的口径细、长度短、数量多,因而总的横断面积大。全身毛细血管总横断面积约为2800平方厘米,约为主动脉横断面积(4平方厘米)的700倍,故其血流缓慢。它还具有管壁薄、通透性大等特点,是循环系统中进行物质交换的主要部位。微循环有调节组…     

子宫腺肌症患者子宫内膜血管内皮生长因子的表述与临床意义

目的:探讨子宫腺肌症患者子宫内膜组织中血管内皮生长因子(VEGF)的表达与间质微血管密度(MVD)与子宫腺肌症发病的关系。方法:30例子宫腺肌症患者通过子宫动脉栓塞治疗,分别于治疗前、后,应用免疫组化S-P法,检测子宫内膜中VEGF的表达,同时选用CD34进行微血管标记并计数。另30例子宫肌瘤患者采用相同的检测进行对比研究。结果:子宫腺肌症患者中VEGF的表达与间质MVD呈正相关(γ=0.752)。子宫腺肌症组VEGF的表达与MVD均高于子宫肌瘤组(P<0.05)。结论;VEGF的表达及MVD增高与子宫腺肌症的发病有关,可作为子宫腺肌症疗效判断的可靠依据。     

Scanning electron microscopic examinations of microvascular casts of the rat liver and bile duct

Microvascular features of normal rat livers and bile duct system were examined with the vascular casts using methacrylated resin. Portal vein branches not only showed regular tapered down bifurcations but also had many side branches, some of which were directly connected with sinusoids. Terminations of hepatic arterial branches were divided into three types: 1) Many branches pouring into peribiliary capillary plexus (PBP), 2) branches directly pouring into periportal sinusoids and/or peripheral portal vein branches via arterio-portal anastomoses, and 3) anastomoses with periportal vascular plexus. PBP was composed of rich vascular networks. In large portal tracts, the plexus showed two layers, that is, the inner layer made up of a close network of capillary vessels and the outer layer consisting of a loose network of arteries and veins, while the PBP in the small portal tracts was composed of only a single layer of loose capillary network. Transitional features of these two patterns were found in the medium-sized portal tracts. PBP was supplied by afferent vessels from the interlobular hepatic artery as described above, and were directly connected with interlobular branches of the portal vein (internal root). The extrahepatic bile duct revealed a much richer vasculature than the intrahepatic bile duct. Both arterial and venous branches were ramified at almost right angle from a pair of arteries and veins running parallel with the bile duct. Occasional strictures, which might have been sphincter portions of the media, were noted at the branching sites of the artery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Angiogenesis and arteriogenesis; the long road from concept to clinical application

In patients with obstructive artery disease, two different forms of compensatory vessel growth occur; angiogenesis and arteriogenesis. Angiogenesis is the formation of a capillary network, through the activation and proliferation of endothelial cells in ischaemic tissue. Arteriogenesis is the transformation of pre-existent collateral arterioles into functional collateral arteries. Circulating blood cells, especially monocytes, play an important role in the arteriogenesis process. Animal experiments have demonstrated that local treatment with monocyte chemoattractant protein-1 results in an elevated accumulation of monocytes/macrophages and an increased growth of collateral vessels. The stimulation of arteriogenesis will probably result in a greater increase in blood flow to the ischaemic tissue, than the stimulation of angiogenesis. This can be explained by the difference in diameter between the collateral vessels formed in arteriogenesis and the capillaries formed in angiogenesis. Research to the efficacy of growth factors that stimulate the arteriogenesis process is still at an experimental stage. The stimulation of arteriogenesis is studied in models of both peripheral and coronary obstructive disease.     

流产手术后妊娠物残留疑似子宫动静脉瘘鉴别诊治分析

子宫动静脉瘘(uterine arteriovenous fistula,UAVF)属于子宫血管病变,是指子宫动脉分支与静脉分支之间绕过毛细血管网出现异常的直接交通.获得性UAVF常继发于子宫的创伤;由于流产手术后妊娠物残留与UAVF的B超表现存在一定的相似性,可能会干扰UAVF诊断的准确性.报道1例流产手术后B超提示...     

The effects of long-term exposure to cadmium on the small blood vessels in the rat uterus: A light microscopic study

A group of female Wistar rats was exposed to 0.5 mg/kg cadmium three times a week for a period of 29 weeks. The cadmium was administered as the chloride in saline by subcutaneous injection. A second group of female Wistars was divided into a control group and and two experimental groups. The animals in the last two groups were exposed to 0.23 and 0.046 mg/kg cadmium three times a week for a period of 82 weeks, likewise administered by subcutaneous injection, to study the long-term effects of cadmium on the microvasculature of the uterus. The small blood vessels in the myometric layer of the uteri were studied. The thickness of the media was analyzed and an inventory was made on the morphology of the media, of the endothelial layer, and of the perivascular connective tissue. A dose- and time-related increase of the thickness of the media could be demonstrated. In the highest dose group, signs of perivascular inflammatory reaction could be observed.     

体外循环致大鼠小肠微循环损伤的实验研究

目的:定量分析研究体外循环(CPB)对小肠微循环功能的影响。方法:建立大鼠常温CPB模型,将20只大鼠分为对照组和CPB组,以异硫氰酸荧光素标记牛清蛋白及吖啶橙作为示踪剂,分别标记血浆和白细胞,采用活体荧光显微镜技术,于CPB前、CPB 30和60 min、停CPB后60和120 min,观察并定量分析小肠壁小动脉直径、收集静脉红细胞流速、功能毛细血管密度、毛细血管通透性和白细胞附壁情况等。结果:CPB可使肠壁小动脉直径减小,收集静脉血流速度减慢,黏膜和肌层功能毛细血管密度减低,血管壁通透性增加和大量白细胞附壁,CPB停止后2 h,各项改变达到峰值。结论:CPB可导致明显而持续的小肠微循环功能损害。     

Endometrial morphological changes in IUD users: a review

The introduction of an intrauterine device into the uterine cavity induces a foreign body reaction in the surrounding endometrium which is characterized by the infiltration of polymorphonuclear leucocytes and macrophages into the endometrial stroma and subsequently through the surface epithelium. Leucocyte migration is greater with copper IUDs than with inert IUDs. Ulceration of the surface epithelium, haemorrhage of erythrocytes and microthrombosis of stomach capillaries occur in the functional endometrium in contact with inert and copper IUDs. In endometrium adjacent to, but not in contact with, the IUD gaps appear in the endothelial lining of small blood vessels without a haemostatic response. The most striking response in endometrium exposed to progesterone-releasing IUDs is the occurrence of dilated, thin-walled vesicles, associated with a thinning of the surface epithelium and a decidual reaction in the stroma. A uniform suppression of the endometrium in progesterone IUD users is always found after six months of treatment, whereas the insertion of IUDs releasing 20-30 micrograms levonorgestrel induce a profound uniform suppression of the functional endometrium throughout the uterus after only four weeks.     

Neuropathology of delayed encephalopathy in cats induced by heavy-ion irradiation

AIM: The pathogenesis of delayed encephalopathy induced by heavy-ion irradiation was investigated experimentally in cats. The left cerebral hemispheres were irradiated with 15-40 Gy of heavy ions (carbon), and histologically and morphometrically examined 12 months later. RESULTS: In the irradiated cerebral white matter the following occurred as the dose increased: astrocytic swelling, then the dilatation of small blood vessels with a fibrous thickening of the wall, and then loosening of the white matter with cavity formation and diffuse albumin deposition. Pathological features of these cavities suggested that they are induced by long-standing edema. Although the dilated vessels were arteries, veins, and capillaries, arteriovenous shunt and damage of the smooth muscle cells of the arterial media were absent. Changes of the cerebral cortex were scarce. Morphometrically, the irradiated cerebral white matter was swollen, and the capillary density tended to be reduced in the deep cortex and subcortical white matter, but this effect was not dose dependent. CONCLUSION: Heavy-ion irradiation induces delayed encephalopathy in cats, preferentially involving the white matter. The cardinal pathogenesis was long-standing edema of the white matter due to vascular hyperpermeability, and the vascular dilatation seemed to be caused by a reduction in the vascular bed and/or hemoconcentration due to hyperpermeability.     

Vascular defects in human endometrium caused by intrauterine contraceptive devices: An electron microscope study

Endometrial blood vessels from hysterectomized uteri of women using intrauterine contraceptive devices (IUDs) were, examined in the electron microscope to search for the location and cause of IUD-associated uterine hemorrhage. The findings revealed vascular gaps in a small percentage of superficial vessels and these gaps were formed from degenerated endothelial cells. Mechanical surface erosion of the endometrium was judged not to be the mechanism of bleeding because the surface epithelium usually was found to be intact by gross and microscopic examination in spite of variable degrees of surface degeneration and denudation. Tentatively, biochemical induction of vascular permeability also did not seem likely. An explanation for IUD-induced uterine bleeding based upon pressure generated between the IUD and the contracting uterus is proposed. Observation of erythrocytes within vessel gaps supports the feasibility that these gaps provide a route for the escape of blood from endometrium exposed to IUDs.     

虎杖提取物对去势大鼠雌激素的影响

目的:研究虎杖提取物对去卵巢大鼠子宫、阴道及垂体-性轴激素变化的影响。方法:选用60只雌性Wistar大鼠,体重250～260g,分为正常组、假手术组,模型组,雌二醇组,虎杖提取物低剂量组,虎杖提取物高剂量组。其中模型组,雌二醇组,虎杖提取物低剂量组,虎杖提取物高剂量组摘除双侧卵巢。给药6周后,麻醉后颈动脉取血分离血清,测血清中雌二醇(E2)、促黄体生成素(LH)等激素,剥离阴道与子宫称重。HE染色观察子宫组织形态学变化。结果:结果显示虎杖提取物能显著提高去卵巢大鼠阴道和子宫重量;改善子宫萎缩状况;虎杖提取物能增加去卵巢大鼠血清E2含量,降低LH含量。结论:说明虎杖提取物增加去卵巢大鼠阴道、子宫重量和改善萎缩状况并改变其血中激素水平,为开发治疗绝经期综合征的新药提供实验依据。     

Anatomy of the breast

The breast develops from the milk streak (mammary ridge), which regresses in the human fetus to the site of the adult nipple. This buds into 15-20 epithelial columns, which canalize before birth in to the lactiferous ducts. At puberty, masses of cells proliferate at their endings. Secreting alveoli develop during pregnancy to secrete milk after delivery. The glandular tissue atrophies after the menopause. The bulk of breast tissue localizes to its upper outer quadrant. It lies mainly on pectoralis major, overlapping onto serratus anterior and rectus abdominis. A tongue, the axillary tail, projects into the axilla. Being an epithelial derivative, the breast is enclosed in its own pocket of superficial fascia, enabling its clean dissection at mastectomy.Its rich blood supply is derived from the internal thoracic (internal mammary) artery and from branches of the axilllary artery, accompanied by the corresponding veins. Lymphatic drainage accompanies these blood vessels, and passes principally to the axillary lymph nodes (divided into levels one, two and three by pectoralis major), and to the internal thoracic nodes, with some drainage passing to the intercostals nodes near the heads of the ribs.