血管内医源性异物三例

心脏大血管医源性异物虽属罕见，但近年来随着导管介入性诊疗术的开展，所用的各类导管、导丝及其他特殊器械在人血管内断裂的事件时有发生，处理不当会引起严重后果。作者从事介入放射工作12年间，已遇到3例血管内导丝、导管折断患者并成功地取出了异物。     

PTCA和支架植入术的临床护理

介入治疗是应用现代高科技手段进行的一种微创性治疗,也就是在医学影像设备的引导下,将特制的导管、导丝等精密器械引入人体,对体内病灶进行诊断和局部治疗。介入疗法的多数项目都是在血管内进行的,它不用开刀,只需把细管子插入血管内即可治疗许多过去无法治疗、必须手术治疗或     

亲水性聚合物微导管—导丝系统在超选择性血管造影中的应用

亲水性聚合物的微导管-导丝系统由导管和导丝组成,导管是柔软的聚氨基甲酸乙酯,其表面涂以亲水性高分子聚合物,导管为3F(外径1.0mm、内径0.55mm)长度分90cm,100cm及110cm三种。导丝直径为0.018时,其长度比导管长2～3cm,前端呈“J”型。MCW超选择血管造影方法是先把5～6 F薄壁塑形导管插入,然后插入MCW至靶血管内,进行超选择血管造影、药物灌注及TAE。临床应用前对此导管经手推或高压注入各种血管造影剂的用量作了研究,作者选用7种造影剂,其中60%Urografin手推为0.8～0.5ml/sec,高压注射(300psi)为2.2ml/sec。76%U-     

留置动脉导管时简易的动脉切开技术

Klopp等最早应用动脉灌注抗癌药治疗恶性肿瘤,最近荒井等应用皮下埋藏法对门诊患者应用动脉灌注抗癌药进行治疗。血管造影时尽可能将导丝插入预定留置动脉灌注的血管,透视下在导丝的前端切开皮肤,暴露出血管内导丝,将其引出血管外,然后沿此导丝将留置导管插入。作者应用此法对6例恶性再发性转移瘤作了研究。其中转移性肝癌4例,胆囊癌1例,子宫颈癌局部再发1例。6例中5例对动脉灌注血管留置3导管,其中肝总动脉2例,肝固有动脉2例,左髂内动脉1例。导入血管经腹壁下动脉2例,颈横动脉1例,胸外动脉1例及甲状颈干1例。亦可经其它动脉导入。应用     

解脱动脉造影导管打结的新方法

血管内导管打结在血管造影并发症中是严重的,但不常见。Syme(1967)报导用手术解除动脉内导管打结。文献已报导4例在透视监视下用非手术使打结导管解脱的技术。Young 和Maurer 处理1例经股动脉插管的5号法国聚乙烯导管打结。使导管由暂时性静置,再快速推动使结松开和增大,导丝进入结内,然后抽拉导管和导丝入髂总动脉使结解开。Hawkins 和Tonkin 处理1例J 形6号法国导管打解病例,用直接转向导丝解脱导管结。Chinichian 等处理1例8号法国headhunter导管打结,经对侧股动脉插入第二支8号法国导管穿过导管结使之解脱的方法。Thomas 和Sievers处理1例7号法国headhunter 导管打结。经对侧股动脉插入猪尾样导管,导入可转向导丝,使其能     

新型介入穿刺针的特点及其临床应用

介入穿刺针是介入治疗时行Seldinger穿刺的一种医疗器械.Seldinger穿刺技术是1953年由Seldinger发明的,先用穿刺针穿刺血管,再用导丝引导导管插入血管的技术.笔者在多年的介入治疗实践中发现,现有的介入穿刺针以及穿刺步骤还有可以进一步完善之处.于是就对现有的介入穿刺针以及穿刺步骤进行了一些改进,并将所改进之后的穿刺针命名为"新型介入穿刺针".笔者就"新型介入穿刺针"的特点及其便捷式穿刺技术的应用具体介绍如下.     

介绍一种介入超选择插管预防气栓形成的方法

气栓是介入超选择插管时的常见并发症 ,常影响造影质量和治疗效果。笔者通过使用注射器外筒很好地解决了这一问题 ,现介绍如下。操作方法 :超选择插管到位后 ,将导引导丝尾端从 5ｍｌ注射器外筒乳头孔中穿过 ,把乳头接牢在导管尾座 ,抬高注射器外筒尾部 ,向注射器外筒内注入肝素生理盐水 ,尔后缓缓拔出浸在肝素生理盐水中穿过的导丝。这样 ,即使血液不能返流至导管尾座 ,导管腔内充盈的是肝素生理盐水 ,术者可依据靶血管粗细用适当压力手推对比剂观察靶血管 ,从而很好地避免了气栓的发生。讨论　当导管所超选择进入的靶血管直径与导管直径大…     

用明胶海绵通过端孔导丝作超选择血管栓塞术

作者在15例病人用端孔导丝行明胶海绵栓塞术。用作栓塞治疗的0.038吋SOS端孔导丝145cm长,有0.0215时的内腔,可与0.018时铂端的175cm长冠状导丝相接作超选择置入。用5或6F血管造影导管在选定血管插管。将0.018时铂端导丝逆向插入SOS导丝,将此组件送入导管,进而将铂端导     

介入放射学血管造影技术

本文介绍与介入放射学有关的各方面的血管造影,仅讨论认为会有帮助的技术。血管造影术介绍(1)血管造影导管时间超过15分钟时,低剂量系统性肝素化的方法。肝素剂量为2000—3000国际单位,通过导管每500毫升灌注液中含肝素1000国际单位。(2)导管腔内血凝闭塞,可引入Teflon 套管于闭塞导管之外,或从导管近皮肤处侧孔,插入导丝,然后拔出闭塞导管,引进新导管的方法。(3)具备良好性能的影象增强电视系统,使用高KV 低MA,及自动调节亮度透视机,     

导管打结的取出经验及教训

病员男,58岁,因肝癌行介入治疗。经右股动脉导管鞘插入 COOK5.5F RH 导管过程中,发现右髂动脉血管明显扭曲,导管进入困难,用 TERUMO 泥鳅导丝引入主动脉。在主动脉弓复型过程中,出现成袢、打结,明显折痕和变细。取法:导管在髂动脉内成袢、打结,其近鞘端有折痕,不能强行拉,更不能旋转退结。我们插入泥鳅导丝并与成袢前旋转的相反方向转动导管,试图使导丝通过折痕处增加其强度,便于退管,但失败。又将导管送至主动脉,使其在较大空间内便于退袢及解结,但导管头端位于主动脉弓而进管几乎无效。在透视下我们又轻轻将导管及鞘同时外拉,当手能扪及折痕处时让另一医     

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.