主动脉瘤的腔内隔绝术介入治疗

目的:讨论腔内人造血管隔绝术治疗主动脉瘤近期临床疗效。方法:4例肾下腹主动脉瘤和1例主动脉弓夹层动脉瘤病人接受腔内人造血管隔绝术治疗,术前均行彩超、三维重建螺旋CT检测。结果:术后即刻DSA造影显示:5例动脉瘤消失,近远端人造血管与主动脉结合处无内漏,腔内人造血管无移位,5例病人临床均获成功。术后3~6个月彩超及CT随访显示腔内人造血管无移位及内漏,动脉瘤残腔无增大及血流。结论:腔内人造血管隔绝术是一种创伤小、恢复快的治疗主动脉瘤的安全、有效的新方法,但远期疗效有待随访。     

内支架置入术治疗胸腹主动脉瘤的临床评价

目的：探讨胸腹主动脉瘤的ESG治疗临床疗效。方法：对10例患者分别行CTA、MRA、DSA检查和ESG治疗，其中Stanford B型夹层动脉瘤6例，真性腹主动脉瘤2例，肾动脉开口以下腹主动脉瘤2例（行分体式支架），所有病例均采用带膜支架。结果：8例行一体式支架腔内隔绝术，2例行分体式支架腔内隔绝术，均获成功。顺利植入，术后造影提示动脉瘤消失．无内漏发生。患者症状完全消失，全部患者在随访期间均未出现术前症状，未见相关并发症。结论：应用ESG治疗胸腹主动脉瘤安全、有效、创伤小、术后恢复快，长期疗效尚待进一步观察。     

腹主动脉瘤腔内隔绝术中内漏动物模型的建立

目的：建立近似人体的腹主动脉瘤（AAA）腔内隔绝术（EVE）后内漏的实验动物模型。方法：采用6只犬 ，以牛颈静脉间置法或前壁补片的方法形成保留腰动脉的肾下型AAA，经髂动脉行AAA EVE，术中采用修剪人造血管和改变支架附着点的方法形成内漏。结果：血管造影示6只犬动脉瘤形态良好，5只犬形成了即时性内漏，内漏来自近端返流，也有近端返流。结论：通过移植物释放位置的变化可以模拟出与人体EVE后相似的即时性内漏，以供血流动力学和治疗研究。     

胸、腹主动脉病变的血管内治疗

目的探讨胸、腹主动脉病变不同血管内治疗方法的临床疗效。方法7例患者,其中DebakeyⅢ型主动脉夹层5例(4例行一体式支架腔内隔绝术,1例行内膜瓣开窗术);DebakeyⅢ型主动脉夹层外院外科人造血管置换术后降主动脉假性动脉瘤形成1例(行一体式支架腔内隔绝术);肾动脉开口以下腹主动脉瘤1例(行分体式支架腔内隔绝术)。结果5例一体式支架腔内隔绝术均获成功,2例出现Ⅰ型内漏,1例经球囊扩张后内漏消失,1例30 min后内漏减少,未处理;1例内膜瓣开窗术后患者双下肢缺血症状消失;1例分体式支架腔内隔绝术后造影提示动脉瘤消失,无内漏发生。结论应用血管内支架移植物或内膜瓣开窗术治疗胸、腹主动脉病变安全有效,其中分体式支架的临床应用具有更好的前景。     

腹主动脉瘤腔内隔绝术后的瘤腔压

本文通过对腹主动脉瘤腔内隔绝术前后动脉瘤腔内动脉压的测量 ,评估术后动脉瘤壁所受负荷的减轻程度 ,并进一步讨论腹主动脉瘤腔内隔绝术的成功标准。1　资料与方法　　肾下型腹主动脉瘤 ,成功放置“人”字型内置人造血管 ,进行腹主动脉瘤腔内隔绝术患者 10例。术前测压导管探头在Ｘ线透视下定位于动脉瘤腔内 ,术后则定位于人造血管和动脉瘤壁之间 (即隔绝后的动脉瘤腔内 )。外接传感器及测压机 ,测量收缩压、舒张压、平均压和脉压差。2　结　果　　腹主动脉瘤腔内隔绝术后 ,动脉瘤腔内收缩压下降(6 2 6± 4 7) %、舒张压下降 (4 4 9± 4 8…     

腔内隔绝术治疗腹主动脉瘤(附2例报告)

目的：探讨腔内隔绝术治疗腹主动脉瘤（AAA）的方法、疗效、并发症及存在的问题。方法：2例高龄、多病并存的AAA患者在全订及动脉造影的监控下，植入血管内支架－聚酯移植物复合体，对AAA进行腔内隔绝术。结果：术后定期复查彩超、CT及血管造影显示支架通畅，无移位、扭曲、支架外壁与瘤腔间充满血栓，未发现搏动的肠系膜下动脉及腰动脉，未发现渗漏。AAA外径无变化。患者腹部搏动性肿块消失。结论：腔内隔绝术治疗AAA避免了外科手术的各种缺点，具有简便、安全、疗效确定等优点。     

覆膜支架在外周动脉瘤及动脉夹层治疗中的应用

目的 探讨覆膜支架在外周动脉瘤及动脉夹层治疗中的可行性及安全性.方法 2008年11月至2012年5月收治24例外周血管病变患者,其中锁骨下动脉假性动脉瘤10例、髂动脉夹层5例、髂动脉假性动脉瘤4例、髂动脉瘤3例、颈内动脉瘤1例、下肢多发动脉瘤1例.所有患者在经股动脉穿刺血管造影明确病变后,植入覆膜支架行腔内隔绝术.结果 所有患者均成功植入覆膜支架行腔内隔绝治疗,即时封闭效果满意,无手术相关并发症.随访2～42个月,有1例锁骨下假性动脉瘤患者在覆膜支架植入后4个月时支架两端又出现假性动脉瘤,再次植入覆膜支架,其余23例患者均未出现相关并发症.结论 覆膜支架腔内隔绝术是一种微创、安全且高效的外周血管完整性修复方法.     

彩超对动脉瘤腔内隔绝术后内漏的诊断价值

目的:探讨彩色多普勒超声对动脉瘤腔内隔绝术后内漏的诊断价值。方法:回顾性分析30例腹主动脉瘤患者腔内隔绝术后二维及彩色多普勒超声表现。结果:30例患者中6例出现内漏,发生率为20%,其中Ⅰ型1例,Ⅱ型4例,Ⅲ型1例。其中5例经CT证实,随访时间延长,3例患者内漏消失。结论:彩超是动脉瘤腔内隔绝术后诊断内漏有价值、可信赖,经济的检查方法。     

腔内人造血管内支撑术治疗腹主动脉瘤

目的 评价腔内人造血管内支撑术治疗腹主动脉瘤的早期临床疗效。方法 自１９９８年２月至１９９９年２月,根据６例腹主动脉瘤患者三维重建螺旋ＣＴ和动脉造影结果,于术前对每个腹主动脉瘤近远端的瘤颈长度、直径和角度,以及动脉瘤和髂总动脉、髂外动脉本身的直径等主要参数进行测量,动脉瘤直径为４．６～８．０ｃｍ,平均６．３ｃｍ;肾动脉下腹主动脉直径为１．８～２．２ｃｍ,平均２．０ｃｍ;近端瘤颈长度为２．５～３．５     

腹主动脉瘤腔内修复术后Ⅱ型内漏的栓塞治疗

内漏是腹主动脉瘤腔内修复术后并发症之一,本院血管外科应用钢圈栓塞治疗Ⅱ型内漏1例,就其经验总结如下. 患者为女性,81岁.于2006年4月24日因肾下腹主动脉瘤(图1)行腔内修复术,置入分叉型人工血管内支架(Zenith,Cook,USA),远端锚定于髂总动脉,保留两侧髂内动脉.患者恢复顺利,术后5 d出院.术后1年随访CTA显示支架形态位置满意,瘤腔内未见明显对比剂充盈,但瘤体直径与术前相比,无明显缩小(最大径仍为6 cm).2008年3月24日因下腹饱胀并扪及搏动性肿块1个月余来诊.     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.