明胶微球阻塞胎羊胎盘血管后的血液动力学变化

明胶微球阻塞胎羊胎盘血管后的血液动力学变化李笑天庄依亮吴国强沈霖霖周光兴常才杨幼明时浩胎盘梗阻、脐动脉血流改变是胎儿窘迫的重要病因之一。但是，目前尚无有效的方法检测脐动脉的压力波形，研究人类胎盘循环的血液动力学特点尚有一定的难度。本实验拟通过建立胎羊...     

TCD血流速度的变化对颈椎病及颅内段血管的临床分析

目的：通过观察眩晕病人的血液动力学变化的特点以研究TCD对于颈椎病及颅内段血管的诊断价值。方法：利用TCD技术检测颅内动脉及椎内动脉及椎一基底动脉系统的血流速度,脉动指数频谱形态与颈椎病及血管狭窄关系。结果：180例眩晕病人中有112例可以观察到双侧椎动脉血流速度不同程度减慢,对112例所有的患者进行颈椎X线摄片发现有90例（83%）患者有颈椎病的X线表现。通过68例脑卒中患者探讨血管狭窄及血管痉挛脑动脉硬化结论分析,血管狭窄及痉挛发作,颅内血流速度均增高98cm/s以上。结论：TCD异常检出率可达成83%,说明眩晕患者有脑血管供血功能异常提示多与颈椎病有关,TCD技术易行且无创伤性。通过68例患者探讨血管狭窄及血管痉挛脑动脉硬化结论分析,脑卒中可提前预防。     

儿童过敏性紫癜合并烟雾病1例病例分析并文献复习

过敏性紫癜又称亨-舒综合征,是以小血管炎为主要病变的系统性血管炎。临床特点为血小板不减少性紫癜,常伴关节肿痛、腹痛、便血、血尿和蛋白尿。多发于2～8岁儿童。烟雾病又名脑底异常血管网,是一组以颈内动脉虹吸段及大脑前、中动脉起始部狭窄或闭塞,脑底出现异常的小血管网为特点的脑血管病。临床上,很难将二者联系到一起,笔者在临床工作中遇到1例过敏性紫癜合并烟雾病患儿,现报道如下。     

正常及高龄孕妇血液流变学的变化

血液流变学是研究血液在血管中流动的规律、血液有形成分（细胞）的变形性和无形成分（血浆）的流动性对血液流动的影响以及血管和心脏之间相互作用的科学。反映血液流变学的指标主要有外周阻力、微循环功能、红细胞压积、血液黏度等。血液流变学指标受年龄、性别、环境因素及生活习惯的影响，如海拔平面、南北地区环境、气候影响等。血细胞生物学行为和血浆蛋白、血脂的质量等因素可通过改变血液黏度，进而引起血液流变性障碍。近十几年来，血液流变学指标检测在临床的应用日趋广泛，且正逐步深入到对产科疾病的诊断、治疗、疗效判定和预防等方面。     

SLE并发股深动脉假性动脉瘤病案

目的:首次报告SLE并发股深动脉假性动脉瘤病案。方法:病例报告并探讨SLE并发腹主动脉瘤与SLE并发股深动脉假性动脉瘤的共同特点。结果:SLE的血管病变不单单只见于大动脉,而且亦可见于周围动脉血管,甚至其他小动脉血管。结论:SLE并发股深动脉假性动脉瘤的临床特点与SLE并发腹主动脉瘤的特点基本相同,即年纪轻,SLE病程长,糖皮质激素应用时间长,有高血压和动脉粥样硬化存在。     

双胎输血综合征研究现状及进展

双胎输血综合征的诊断目前多采用Quintero诊断分级标准。但很多研究认为,应在其基础上加入胎儿心血管功能状况和胎盘血管有无动脉－动脉交通支存在的评估。双胎输血综合征治疗方法飞速发展,对严重病例现多同时采用系列羊水减量术、胎儿镜下激光凝结胎盘血管交通支术和羊膜中隔微型穿孔术3种方法以提高疗效。虽血管活性物质可能导致双胎输血综合征发病,但成功模拟的双胎输血综合征疾病进展模型显示,胎盘血管交通支在其病理生理机制中起关键作用。     

温差电偶法与电磁流速计测量胎盘血流量的比较

子宫胎盘血流量与灌流压力成正比而与因子宫收缩产生对血管的压力成反比。目前对胎盘血流量的调节比对其它任何器官的血流量调节了解得都少。母体胎盘血流来源于两条子宫动脉和两条卵巢动脉,由于是数条动脉分数支供给子宫血液,而胎盘部分及非胎盘组织两部分血流分布又无法精确定位,因此只测量一条动脉的血流量难以得出胎盘血流量的结论。本文采用温差电偶法与电磁流速计方法分别测定胎盘微循环血流量以作出比较。温差电偶法的原理是产热的生物体内由于血液流动使热量丢失,这种温度的变化可以用温差电偶     

宫颈癌脑转移诊治研究进展

宫颈癌脑转移非常少见，常在疾病进展后期发现。脑转移的临床表现取决于病变的部位，头痛、偏瘫、面瘫和癫痫发作是脑转移常见的症状和体征。目前，尚无标准有效的治疗方法，其治疗主要包括手术、放疗、化疗、靶向治疗及免疫治疗，其中放疗包括全脑放射治疗和立体定向放射治疗。宫颈癌脑转移患者的预后受多种因素影响，往往预后不良。本文主要综述了宫颈癌颅脑转移的临床特点、诊断、治疗及预后的研究进展。     

动脉硬化的三级预防

人体的心血管系统由动脉、小动脉、毛细血管、小静脉及静脉组成，承担着运输血液、维持全身脏器血供的作用。通俗地讲，人体内供血给心脏和大脑的血管叫中心血管，其余血管则叫外周血管。血管有动脉、静脉之分。动脉管壁较厚，平滑肌较发达，弹力纤维较多，管腔断面呈圆形，具有舒缩性和一定的弹性，可随心脏的收缩、血压的高低而明显地搏动。因此，通常讲的脉搏，即通过触摸前臂、足背、大腿、胭窝、颈部等处动脉的波动而获得，可以通过动脉搏动次数来评估心脏跳动的频率。     

胎儿宫内窘迫时的胎儿胎盘血液动力学改变

目的：评价彩色多普勒超声检查在围产儿监护方面的价值。方法：对２２例胎儿宫内缺氧（宫内窘迫组）和６例围产儿死亡（围产儿死亡组）的胎儿胎盘血管超声结果进行分析，同时与同期５５５例妊娠３６～４０周正常妊娠胎儿（正常妊娠组）比较。使用仪器为ＵＭ９ＨＤＩ彩色多普勒超声诊断仪。结果：与正常妊娠组比较，胎儿宫内窘迫组胎儿肾动脉、脐动脉和胎盘床动脉阻力均显著升高，大脑中动脉阻力无变化；围产儿死亡组中，除胎儿外周血管阻力升高外，其大脑中动脉阻力明显降低，以及脐动脉和肾动脉舒张期血流缺如或返流。结论：胎儿宫内缺氧使胎儿血液动力学发生明显的变化，血液动力学变化，对预测胎儿宫内缺氧具有一定的价值。     

Treatment of intracranial aneurysms during pregnancy

Aneurysmal subarachnoid hemorrhage (SAH) during pregnancy is rare but serious obstetric complication. SAH occurs more often in primiparae and in the third trimester of pregnancy. The hemodynamic and endocrine changes play an important role in the growth and rupture of aneurysms. There are no differences in the clinical course of SAH among pregnant and non-pregnant patients. Subarachnoid hemorrhage during pregnancy may be confused with eclampsia. The confirmation of the diagnosis is made by computed tomography (CT) or lumbar puncture and cerebral angiography. Ruptured intracranial aneurysms should be treated as they would be in patients who are not pregnant. When the aneurysm is successfully clipped, the pregnancy can be allowed to progress to term. In these cases the vaginal delivery is preferred by most clinicians. Caesarean section would be indicated in several circumstances: when the clinical state of mother is severe (coma, brain stem damage), if the aneurysm is diagnosed at term of labour, if the interval between the neurosurgical treatment of aneurysm and labour is less than 8 days.     

Impact of pregnancy on the size of small cerebral aneurysm

Objective: Because the management of cerebral aneurysms during pregnancy remains controversial, the objective of this study was to perform a retrospective review of pregnant women with cerebral aneurysms to determine whether pregnancy is a risk factor for aneurysm rupture.

Methods: The change in size of aneurysms during pregnancy was examined by performing repeat magnetic resonance angiography in five pregnant women with cerebral aneurysms between 2005 and 2013. The outcome examined was development of subarachnoid hemorrhage.

Results: Among the five pregnancies, there were eight cerebral aneurysms. Subarachnoid hemorrhage did not developed during any pregnancy. In four of the pregnancies, the cerebral aneurysms did not change in size during pregnancy, remaining 2–5?mm. Although in one pregnancy, the aneurysm increased from 6 to 7?mm during the third trimester, it returned to its original size in the postpartum period.

Conclusions: We suggest that if the cerebral aneurysm is small (≤?5?mm), it is likely to remain unchanged despite the increase in circulating blood volume during pregnancy. Cerebral aneurysms greater than 5?mm but without blebs, irregular shape, high-risk location, or increased aspect ratio are also at low risk of rupture and are not likely to change during pregnancy.     

川崎病冠脉瘤远期血管改变与冠脉粥样硬化关系研究

摘要：目的　探讨川崎病（KD）冠脉瘤远期血管改变及其与冠脉粥样硬化的关系。方法　选择首都医科大学附属北京儿童医院2008年6月至2009年6月病程大于1年且合并中型以上冠脉瘤的KD患儿31例为研究对象（KD冠脉瘤组）,以CD34/CD133/KDR+为血管内皮祖细胞（EPC）表面分子标记,用流式细胞仪测定血周血EPC数量;采用酶联免疫法测定血清超敏C反应蛋白（hs-CRP）;全自动生化分析仪测定血脂及载脂蛋白。选取年龄、性别匹配的21名健康体检儿童作对照（对照组）。结果　KD冠脉瘤组患儿病程1.0～12.5年,中位病程2.5年;中型冠脉瘤9例,巨大瘤22例,12例存在心肌缺血证据。KD冠脉瘤组血清hs-CRP为（2.77±1.06） mg/L,对照组为（1.60±1.53） mg/L,KD冠脉瘤组显著升高（P < 0.01）。外周血EPC及血脂两组比较差异无统计学意义（P > 0.05）。结论　KD冠脉瘤组恢复期血清hs-CRP显著升高,提示仍有慢性炎症反应,可能与KD成年后早发动脉粥样硬化有关。     

Relationship between proteolytic enzymes and atherosclerosis in aortic aneurysms.

Aortic elastase and aortic collagenase were assayed in 38 patients who underwent an operation for thoracic or infrarenal aneurysm or infrarenal aortic occlusive disease and in 15 control patients (heart or kidney donors). Elastase was elevated in normal aortas of the infrarenal region (1.10 milliunits per gram, p less than 0.05), and in atherosclerotic descendens aneurysms (1.24 milliunits per gram, p less than 0.05), compared with the ascending aorta, when normal; aneurysmatic specimens revealed similar low elastolytic activities (0.10 milliunits per gram). The highest elastase content was found in infrarenal aneurysms (4.65 milliunits per gram). Collagenase assays yielded no significant differences, although higher activities were extracted from aortas of the infrarenal region. Coexistent atherosclerosis and wall destruction were evaluated by macroscopic and histologic investigation. All infrarenal specimens demonstrated severe atherosclerotic wall degeneration with depletion of elastic fibers. As the atherosclerotic specimens did not differ from normal aortas by protease assay, the higher elastase of infrarenal samples compared with the thoracic aorta suggests a more rapid fiber metabolism in the infrarenal region. The significantly elevated elastolytic activity of infrarenal aneurysms points to the decisive role of elastase in infrarenal aneurysm formation.     

Detection and assessment of circle of Willis aneurysms in acute subarachnoid hemorrhage with three-dimensional computed tomographic angiography: correlation with digital substraction angiography findings.

In this retrospective study, we examined the usefulness of computed tomographic angiography (CTA) for the detection and assessment of circle of Willis aneurysms in patients with acute nontraumatic subarachnoid hemorrhage (SAH), using selective digital substraction angiography (DSA) as the gold standard. Thirty-five patients who presented with acute, nontraumatic SAH, diagnosed on the basis of unenhanced computed tomography or lumbar puncture findings or both, underwent both CTA and DSA. The CTA images were interpreted for the presence, location, size, and shape of the aneurysm, presence of a neck, and relationship of the aneurysm to adjacent arterial branches. The CTA and DSA images were then compared, with the latter images serving as the gold standard. DSA revealed 37 aneurysms in 32 patients and ruled out intracranial aneurysms in the remaining three. The sensitivity and specificity of CTA for aneurysm detection were 97% and 100%, respectively. The size of the smallest aneurysm shown was 4 mm, and the largest aneurysm was 21 mm. The size and lobularity of the aneurysms estimated from CTA images corresponded well with those estimated from DSA images. In addition, CTA provided a three-dimensional representation of the aneurysmal lesion, which was considered useful for surgical planning. Our results confirm the accuracy of CTA in comparison with DSA. Because of its reliability, minimal invasiveness, and rapidity, CTA may become the technique of choice for neuroradiologic work-up of SAH patients. DSA then would be used to diagnose intracranial aneurysms only in selected, questionable cases.     

Ruptured intracranial aneurysms during pregnancy. A report of four cases

Four patients presented with ruptured intracranial aneurysms during pregnancy. Problems encountered during the management of these cases included delayed diagnosis, obstructive hydrocephalus, cerebral ischemia due to vasospasm and recurrent subarachnoid hemorrhage. Recent advances in the management of ruptured intracranial aneurysms, including early computerized tomographic scanning, intravascular volume expansion and induced hypertension for the management of cerebral vasospasm, and the timely obliteration of the aneurysm are applicable to the subarachnoid hemorrhage patient even if her condition is complicated by pregnancy.     

Review of arterial thoracic outlet syndrome with a report of five new instances

Arterial damage, causing ischemia of the limb, occurs in less than 5 per cent of all instances of thoracic outlet syndrome. Arterial complications are usually associated with cervical ribs or rudimentary first ribs, but 12 per cent have occurred in patients with no osseous abnormality. The physiopathologic factors begin with compression of the subclavian artery which, in most patients, produces stenosis, poststenotic dilatation, formation of aneurysms and mural thrombosis. In other patients, aneurysms do not form, but the compression still causes stenosis, intimal injury and mural thrombosis. With either scenario, distal embolization can occur and produce signs and symptoms of ischemia that can limb-threatening. In this study, more than 200 patients reported previously and five additional sides in four patients were reviewed. Treatment depends upon the condition of the patient at presentation. Those with osseous abnormalities and no aneurysm or symptoms are not treated, while those with poststenotic dilatation or small aneurysms undergo rib resection only. Aneurysms more than twice the arterial diameter, intimal injury or mural thrombus are indications to resect, replace or bypass the subclavian artery. Patients who have had distal embolization and severe ischemic symptoms require, in addition to the aforementioned, distal thromboembolectomy, dorsal sympathectomy or both. Good results from treatment have been reported in 84 per cent of the 137 patients reported since 1970; 3 per cent required amputation and 3 per cent had cerebral emboli. Because the severe arterial complications were primarily the result of delayed therapy, they can best be avoided by early recognition, diagnosis and treatment.     

First report of an unusual,rare complication of pregnancy: rupture of multiple lienal vein aneurysms

Lienal vein aneurysms are a very unusual pathology. Usually they are extremely rare incidental findings, associated with many diseases as hepatic cirrhosis, portal hypertension and other conditions as pregnancy. We report here the case of death of a mother and her fetus at the third trimester of her third pregnancy due to haemoperytoneum for rupture of aneurysm. The autoptic examination revealed the presence of three fusiform and saccular aneurysms of the lineal vein. The histopathological features of aneurysms’ wall are described. The aetiopathogenetic hypothesis of the lesion is discussed. To our knowledge this is the first case report describing the sudden death of pregnant woman and fetus from a rupture of maternal lineal vein aneurysm, complication of multiple aneurysms.     

川崎病患儿血管内皮细胞抗体检测临床意义分析

探讨血管内皮细胞抗体（AECA）检测对川崎病（KD）患儿诊断及预后评价。方法　2007年8月至2008年5月在广州市儿童医院住院的5岁以下KD患儿55例,采用以人脐静脉内皮细胞和猴骨骼肌为基质的间接免疫荧光技术检测55例急性期KD患儿和43例对照组（发热对照23例,健康对照20名）血清中AECA,并通过比较AECA阴性和阳性组相应的实验室、临床指标,初步评估AECA对KD早期诊断、预后转归的临床应用价值。 结果　KD患儿中AECA阳性率为40.0%,明显高于健康对照组（5.0%, P = 0.004）,但与发热对照组差异无统计学意义（17.4%,P = 0.053）;AECA对KD诊断的灵敏度为40.0%,特异性为88.4%,阳性预测值与阴性预测值则分别为80.0%、53.5%,准确率为60.4%。抗中性粒细胞浆抗体（ANCA）、蛋白酶3抗体（抗-PR3）阳性KD患儿中AECA阳性率显著高于阴性者（P值分别为0.013、0.034）。AECA阳性组与阴性患儿组临床指标、实验室指标差异无统计学意义。AECA阳性组冠状动脉瘤发生率高于阴性组（P < 0.05）,发生动脉瘤的相对危险度为6.67（95% CI 1.2～36.1）。结论　AECA检测对KD的早期诊断价值有限,但对冠状动脉瘤的发生具有预警意义。AECA可能与抗-PR3相互协同在KD冠状动脉损伤、进展至动脉瘤过程中起一定的作用。     

Altered aortic protease and antiprotease activity in patients with ruptured abdominal aortic aneurysms

Aortic elastase, antiprotease (a-1-antitrypsin) and total protein were assayed in 37 patients who underwent an operation on the abdominal aorta for ruptured abdominal aortic aneurysms (AAA), an elective procedure for AAA or aortofemoral bypass for occlusive disease. Aortic elastase modified by local antiprotease activity (elastase/a-1-antitrypsin) was significantly higher in patients with a ruptured AAA compared with patients with an elective AAA or occlusive aortic disease: 241 nanograms per milligram of tissue in AAA-rupture versus 57 nanograms per milligram of tissue in AAA-elective versus 32 nanograms per milligram of tissue for occlusive (p less than 0.003). Patients with a ruptured AAA had the highest elastase activity (354 nanograms per milligram of tissue) and the lowest a-1-antitrypsin (1.07 nanograms per milligram of tissue) compared with patients with an elective AAA and occlusion (p less than 0.05). These data suggest that the homeostatic balance between elastase and antiprotease may be significantly altered in the aortic wall at the time of aneurysm rupture. Increased elastase unchecked by low antiprotease results in increased elastin breakdown which may be the inciting event for rupture of a compromised, thin aortic aneurysm wall.