颈动脉斑块内血管新生与急性缺血性脑血管病的相关性：对比增强超声研究

目的：探讨颈动脉斑块内血管新生与急性缺血性脑血管病的相关性。方法纳入接受颈动脉粥样硬化斑块对比增强超声检查的患者,根据脑缺血症状分为有症状组和无症状组,并根据常规血管超声将斑块回声特征分为低回声组、等回声组和不均质回声组。并采用对比增强超声检测颈动脉斑块内血管新生。采用多变量 logistic 回归分析确定颈动脉斑块内血管新生与急性缺血性脑血管病的相关性。结果共纳入73例急性缺血性脑血管病患者,有症状组32例(19例急性脑梗死,13例短暂性脑缺血发作),无症状组41例;斑块回声特征：低回声15个,等回声41个,不均质回声17个。有症状组斑块增强患者构成比(84．4%对61．0%;χ2=4．802, P =0．028)和增强强度[(21．78±8．50)dB 对(15．93±8．82)dB;t =2．440,P =0．018]均显著高于无症状组。低回声组、等回声组和不均质回声组斑块增强患者比例分别为93．3%、58．5%和82．4%(χ2=7．826,P =0．020),低回声组和不均质回声组显著高于等回声组(P 均<0．05),但低回声组与不均质回声组间无显著性差异(P >0．05)。低回声组、等回声组和不均质回声组斑块增强强度分别为(22．62±9．33)dB、(14．38±8．02)dB 和(18．15±9．64)dB( F =3．877,P =0．027),低回声组显著高于等回声组( P =0．024)。多变量 logistic 回归分析显示,斑块内新生血管(优势比3．456,95%可信区间1．103~10．828;P =0．033)与急性缺血性脑血管病独立相关。结论颈动脉斑块内新生血管与急性缺血性脑血管病密切相关。     

超微血管成像对颈动脉斑块内新生血管的诊断价值

目的对比超微血管成像(SMI)和超声造影(CEUS)对颈动脉斑块内血管的诊断价值。方法选取50例颈动脉斑块患者,以CEUS的结果作为参考标准,分别使用SMI和CEUS进行斑块处血管检测,分析不同回声斑块SMI评分,并对比SMI和CEUS对颈动脉斑块内血管的显示能力。结果 SMI检查50例患者共有70个斑块,其中13个低回声、41个等回声和16个混合回声;颈总动脉分叉处41个、颈总动脉中段17个、颈内动脉12个。使用SMI和CEUS对斑块内强回声进行评级,二者无统计学差异(P>0.05),SMI具有较好的诊断准确性。结论 SMI技术可以清晰呈现颈动脉斑块内血管的新生和分布情况,可以对斑块的稳定性做出准确评价,而且操作简单方便,安全无创。     

超微血流显像与超声造影评价极低回声区斑块内新生血管分布的研究初探

目的:探讨超微血流显像(SMI)技术在评价存在局限性极低回声区(JBA)的颈动脉粥样硬化斑块内新生血管的价值。方法:选取存在JBA的颈总动脉及颈内动脉起始段的低回声或低回声为主的不均质斑块进行SMI和超声造影(CEUS)检查,对检查结果进行对比,评估这些斑块内的新生血管状况。结果:SMI和CEUS检查显示38例存在JBA的斑块内均可见新生血管。斑块厚度0.21～0.63cm,平均(0.38±0.10)cm;斑块长度0.90～5.2cm,平均(2.21±1.06)cm;SMI及CEUS显示斑块内新生血管分级为1～2级,但在JBA区域未见明显新生血管。结论:有JBA的颈动脉粥样硬化斑块内新生血管比率高,但新生血管并不在JBA区域内。     

超声造影对颈动脉粥样硬化斑块新生微血管的评价

目的:探讨超声造影对冠心病颈动脉粥样硬化斑块新生微血管评价的价值。方法:选择冠心病患者62例(CHD组),同期健康体检者62例(健康对照组),均接受超声造影检查,观察两组受检者斑块情况,并比较斑块达峰时间(TTP)、曲线下面积(AUC)、最大峰值强度比(IMAX%)。结果:与健康对照组比较,CHD组软斑(8.06%比56.45%)、硬斑(3.23%比25.81%)、混合斑(1.61%比17.74%)检出率明显提高(P均=0.001),TTP[(22.04±3.41)s比(17.69±3.62)s]明显降低,IM AX%[(50.11±4.12)%比(68.25±6.29)%]和AUC[(1485.62±254.13)Db/s比(2312.15±352.69)Db/s]明显增加(P均=0.001)。超声造影显示CHD组患者颈动脉低回声斑呈弥漫性增强,溃疡斑呈溃疡周边线状增强;健康对照组颈动脉斑块影像无明显增强。结论:超声造影可判断动脉粥样硬化斑块性质,对新生微血管丰富程度进行评估,为临床提供参考。     

颈动脉支架置入术后再生斑块稳定性的超声造影评估

目的评估颈动脉支架置入术后再生斑块稳定性的超声造影情况。方法选取该院2016-01~2019-08收治的40例颈动脉支架置入术后再生斑块患者为研究对象,二维超声检查出65个再生斑块。根据颈动脉粥样硬化斑块二维超声特征分为软斑组(n=29)、硬斑组(n=21)和混合斑组(n=15),观察斑块(超声造影)显影情况,并进行定量分析。结果软斑组新生血管分级高于硬斑组和混合斑组(P<0.05),硬斑组和混合斑组新生血管分级差异无统计学意义(P>0.05);软斑组增强率均高于硬斑组和混合斑组,混合斑组增强率高于硬斑组(P均<0.05);软斑组峰值强度、达峰时间及平均渡越时间均显著低于硬斑组和混合斑组(P均<0.05),硬斑组和混合斑组峰值强度、达峰时间及平均渡越时间比较差异无统计学意义(P>0.05)。结论超声造影能显示颈动脉斑块新生血管,判断颈动脉支架置入术后再生斑块稳定性,对防止脑血栓形成具有重要意义,有较好的实用价值。     

颈动脉粥样硬化斑块与缺血性脑血管病的相关性

目的通过超声造影成像技术的新生血管增强程度评价颈动脉粥样硬化斑块与缺血性脑血管疾病之间的关系。方法将有颈动脉斑块病变的患者分为两组,一组为缺血症状组(63例),另一组为无缺血症状组(27例),对患者颈动脉硬化斑块进行超声造影检查,重点观察颈动脉硬化斑块内新生血管的血流灌注情况,比较有脑缺血症状患者组与无脑缺血症状患者组的颈动脉斑块内新生血管密度及造影增强程度的组间差异。结果有脑缺血症状患者组斑块的造影后增强强度(EI)及ratio值(误差比率值)明显高于无临床症状患者组(P0.05)。结论超声造影可显示斑块内新生毛细血管的再生情况,可以依据斑块内造影剂增强强度预测缺血性脑血管病发生风险的有效指标。     

颈动脉斑块内钙化分布特征对斑块稳定性的影响

目的探讨颈动脉斑块内钙化分布特征对斑块稳定性的影响。方法选择行颈动脉内膜剥脱术患者49例,且术前通过二维超声及超声造影观察颈动脉斑块回声类型及斑块内造影剂分布情况,记录斑块回声类型、钙化部位、形态、数量及钙化旁有无新生血管,并进行分组,以术后病理结果为金标准,比较各组内不同钙化特征对斑块稳定性的影响。结果不同部位各钙化组、不同形态各钙化组及钙化旁有无新生血管的斑块稳定性比较,差异无统计学意义(χ~2=0. 415,P=0. 813;χ~2=2. 164,P=0. 339;χ~2=3. 352,P=0. 095);不同数量各钙化组的斑块稳定性比较,差异有统计学意义(χ~2=5. 555,P=0. 029)。结论钙化数量对颈动脉斑块稳定性有一定影响,多发钙化可导致斑块不稳定。     

兔颈动脉硬化斑块新生血管生发规律的研究

目的应用超声造影技术观察斑块内血管新生在实验性动脉粥样硬化斑块中的生发规律及分布特点。方法将48只日本大耳白兔分随机分为正常组(12只)、对照组(12只)和模型组(24只)。正常组由普通饲料喂养,对照组予以假手术+高脂饲料喂养,模型组予以高脂饲料喂养+球囊拉伤。每周超声检查颈动脉,每两周行颈动脉超声造影检查。超声检查确认造模成功后,目标血管取材进行病理学及免疫组化检测。结果第4周模型组造模成功,8周时70%以上动物出现明显的颈动脉硬化斑块;低回声及混合回声斑块内增强信号较动脉外膜上增强信号密度大,主要集中于斑块的肩部,强回声斑块内部及管壁附着处未见明显增强信号。结论内膜损伤是颈动脉斑块形成的关键因素及始动环节,斑块内新生血及外膜滋养血管随斑块的生长而增多,外膜上滋养血管增生与斑块内血管新生具有一致性,斑块内新生血管可能主要由外膜滋养血管衍生而成。     

稳定型与不稳定型心绞痛患者颈动脉硬化斑块新生血管超声造影特点的对比研究

目的:探讨稳定型与不稳定型心绞痛患者颈动脉粥样硬化(CAS)斑块内新生血管超声造影(CEUS)特征性改变。方法:对临床经心电图、动态心电图或平板运动试验心电图诊断的冠心病患者111例,其中稳定型心绞痛(SA)患者53例,不稳定型心绞痛(UA)患者58例,分别进行颈动脉彩色多普勒超声及CEUS检查,使用声学定量分析软件(Sono Liver)对图像进行分析,比较斑块达峰时间、最大峰值强度比、曲线下面积,分析斑块内新生血管与SA及UA的相关性,并行血清高敏C反应蛋白(hs-CRP)检测进行对比。结果:UA与SA患者CAS斑块内新生血管显像特征存在差异,UA患者CAS斑块内新生血管等级评分较SA患者中明显增高:UA组斑块内新生血管发生率明显高于SA组(P0.05),UA组达峰时间更快、最大峰值强度比及曲线下面积更大,与SA组相比有统计学意义(P0.05);血清hs-CRP浓度UA组也较SA组升高(P0.05);CAS斑块内新生血管等级评分与血清hs-CRP浓度水平呈正相关。结论:CEUS技术观察CAS斑块内新生血管等级评分,为临床对UA进行早期预测及干预,以及对UA预后的判断提供重要的依据。     

高分辨磁共振成像与超声检查对颈动脉粥样硬化评价的对比研究

目的比较高分辨MRI与超声检查对颈动脉粥样硬化的评价。方法选择经超声诊断为颈动脉狭窄≥50%的患者100例,进行主动脉弓上血管对比增强磁共振血管造影(CEMRA),对狭窄侧颈动脉做高分辨颈动脉斑块MRI,判断颈动脉斑块类型。比较MRI对血管腔狭窄及斑块形态诊断与超声的差异。结果与数字减影血管造影比较,CEMRA判断血管狭窄程度的准确性为100%,明显高于超声的准确性74%。超声显示,硬斑和均匀低回声的脂质型斑块相当于MRI的AHA标准Ⅲ和Ⅶ期,较大低回声和不均质混合型斑块相当于Ⅳ～V期和Ⅵ期。结论 MRI对斑块分期更准确,可充分显示硬化斑块的形态结构,判断血管管腔狭窄程度有较高的准确性。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.