The Current Management of Vascular Birthmarks

Abstract: Two vascular birthmarks are hemangiomas and vascular malformations. Hemanglomas grow by cellular proliferation. Their hallmark is rapid neonatal growth. Spontaneous regression begins when the Infant is 6 to 10 months old, but It may continue until 8 to 10 years of age. Hemangiomas are infrequently life-threatening. Pharmacotlogic treatment Is indispensible; unsightly sequelae require surgical treatment. Vascular malformations consist of dyspiastic vessels and are present on a lifelong basis. They are either slow-flow (capillary, venous, lymphatic) or fast-flow anomalies with arteriovenous shunting. Complex combined vascular malformations are observed as well. Ten years ago angiographic studies dearly demonstrated the differences among the various lesions. Today a noninvasive diagnostic approach is recommended, particularly in children. Ultrasonography, Doppler flow imaging, and magnetic resonance imaging are the most informative techniques, revealing the extent of tissue Involvement and differentiating fast-flow from slow-flow anomalies. Risks and management differ depending on the type of vascular malformation.     

Prospective assessment of carotid bifurcation disease with spiral CT angiography in surface shaded display (SSD)-technique

Purpose: To decide, whether spiral CT-angiography (CTA) in surface shaded display (SSD)-technique is suitable for accurate quantification of carotid artery stenoses. Material and Methods: Forty-four patients (25 male, 19 females) with a total of 80 symptomatic carotid artery stenoses were studied prospectively with selective cerebral angiography and spiral CTA in SSD-technique. The degree of stenosis was determined according to the NASCET-study. Results: Assessment of the degree of stenoses with CTA and angiography was the same in 36% of mild stenoses, in 64% of moderate stenoses, in 68% of severe stenoses, and in 95% of the occluded internal carotid arteries. Overall, CTA in SSD-technique showed equivalent results as selective cerebral angiography in 65% of all cases. Conclusion: Spiral CTA in SSD-technique is inferior to selective cerebral angiography. Calcified plaques, vessel opacification and thresholding influence the most grading of stenoses.     

主动脉瘤的影像监测及手术方案设计

主动脉瘤腔内修复主要依靠放射显像技术进行术前监测、术中处理和术后随访。超声、计算机断层扫描(CT)、磁共振成像(MRI)和血管造影在不同的治疗阶段发挥不同的作用,通常一种成像方式通过提供补充信息来支持另一种成像方式。多种影像学检查的数据必须综合成一个连贯的计划才能对主动脉瘤患者进行治疗和随访。本文拟对目前主动脉瘤影像检查方面已经确定和正在更新的经验进行总结。     

联合血管重建胰十二指肠切除治疗胰头恶性肿瘤

目的: 探讨提高联合血管重建胰十二指肠切除率和方法.方法: 回顾总结1994年4月至2004年5月间多家医院79例联合血管重建胰十二指肠切除术的临床资料.本组79例行胰十二指肠切除,其中1例胰头癌累及结肠肝曲合并右半结肠切除.全组联合肠系膜上静脉(SMV)-门静脉(PV)切除,其中合并肠系膜上动脉(SMA)和肝动脉(HA)一同切除重建4例,合并SMA或HA切除重建分别为7例和4例.2例胰头癌因与下腔静脉(IVC)前壁粘紧不能分开则合并下腔静脉前壁部分切除修复.结果: 本组病例围手术期死亡4例(5%).无胆胰瘘及人工血管感染并发症.病理检查结果:胰腺神经内分泌恶性肿瘤1例,其余均为腺癌,切除血管内膜和胰腺切缘经病理检查均无肿瘤浸润.本组失访2例.随访时间3~120个月,9例死于术后7个月~4年,其中7例为合并SMA或HA切除重建者.存活超过3年者37例,超过5年者11例.其余病例尚在随访中.结论: 在选择适宜的病例中施行联合切除血管的胰头癌根治术可提高肿瘤切除率,延长患者存活时间,手术安全.     

经导管接触溶栓与单纯静脉药物溶栓治疗下肢深静脉血栓的对比分析

目的探讨经导管接触溶栓治疗下肢深静脉血栓形成(DVT)的临床疗效,并与单纯静脉溶栓治疗的疗效进行比较。方法收集我院2008年7月至2012年1月期间共437例急性下肢DVT患者,男184例,女253例;年龄(43±12)岁(19～76岁);左侧355例,右侧54例,双侧28例;混合型211例,中央型147例,外周型79例。对其中358例中央型及混合型DVT患者的临床资料进行回顾性分析总结,其中行经导管接触溶栓治疗(经导管接触溶栓组)293例,置管前植入下腔静脉滤器32例;单纯静脉溶栓治疗(单纯静脉溶栓组)65例,植入下腔静脉滤器4例。以治疗前后患肢周径差、溶栓并发症、远期通畅率及瓣膜功能情况为指标评价疗效。结果经导管接触溶栓组治疗前、后大腿和小腿的周径差分别为(7.02±2.17)cm和(4.59±2.85)cm,单纯静脉溶栓组分别为(6.34±2.09)cm和(3.87±2.82)cm,经导管接触溶栓组大腿和小腿的周径差均明显大于单纯静脉溶栓组(P<0.05)。随访(26±6)个月(6～48个月)。经导管接触溶栓组出现穿刺处血肿3例,滤器移位1例,牙龈出血或肉眼血尿4例;单纯静脉溶栓组牙龈出血或肉眼血尿5例。经导管接触溶栓组深静脉瓣膜保存率为(78.2±12.6)%,明显低于单纯静脉溶栓组的(91.1±10.7)%,2组间比较差异有统计学意义(P<0.05);经导管接触溶栓组的远期静脉通畅率为(65.2±15.4)%,单纯静脉溶栓组为(63.8±16.3)%,2组间比较差异无统计学意义(P>0.05)。结论经导管接触溶栓及外周静脉溶栓均能有效减轻症状,经导管接触溶栓可以缩短病程时间,但增加深静脉瓣膜损伤。     

四环素抑制实验性大鼠腹主动脉瘤形成的初步研究

目的；研究四环素对实验性大鼠腹主动脉瘤形成的作用。方法：建立大鼠腹主动脉瘤弹力蛋白酶灌注模型，随机分为实验组（10只）皮下注射四环素（25mg/d)，对照组（10只）皮下注射生理盐水，观察两组动脉瘤形成率和动脉瘤组织学改变，并应用免疫组织化学和分子原位杂交技术检测基质金属蛋白酶－2和9的表达。结果：灌注2周后实验组大鼠腹主动脉瘤形成率10％，对照组大鼠动脉瘤形成率为10％，两组差异有显著意义（P＜0．05），实验组大鼠动脉壁组织MMP－2，MMP－9蛋白表达为弱阳性或阴性，对照组动物瘤组织中两者表达明显增高，两位杂交检测结果表明两组mRNA表达强度无明显差异。结论：四环素能够降低基质金属蛋白酶－2和9的表达，从而减低动脉壁组织弹力纤维的降解，抑制实验性大鼠腹主动脉瘤的形成。     

血管镜下股浅静脉瓣膜修复成形术12例分析

目的 探讨血管镜直视下股浅静脉壁外瓣膜修复术治疗深静脉瓣膜功能不全的可行性和效果。方法 通过血管镜从大隐静脉断端导入至股浅静脉第1对瓣膜近侧，同时阻断股总、股深、股浅静脉，应用含肝素的冲洗液建立清晰水柱，直接观察瓣膜的形态、缺损和变形的程度，对12例原发性深静脉瓣膜功能不全患者实施直视下壁外静脉瓣膜成形术。结果 12例术后行静脉顺行造影证实9例患肢股浅静脉第1对瓣膜返流基本消失，3例静脉瓣膜返流明显改善，无静脉血栓和其他并发症。结论 血管镜直视下行股浅静脉瓣膜壁外修复术准确有效、微创和安全。     

The effect of collagen I mimetic peptides on mesenchymal stem cell adhesion and differentiation,and on bone formation at hydroxyapatite surfaces

Integrin-binding peptides increase cell adhesion to naive hydroxyapatite (HA), however, in the body, HA becomes rapidly modified by protein adsorption. Previously we reported that, when combined with an adsorbed protein layer, RGD peptides interfered with cell adhesion to HA. In the current study we evaluated mesenchymal stem cell (MSC) interactions with HA disks coated with the collagen-mimetic peptides, DGEA, P15 and GFOGER. MSCs adhered equally well to disks coated with DGEA, P15, or collagen I, and all three substrates, but not GFOGER, supported greater cell adhesion than uncoated HA. When peptide-coated disks were overcoated with proteins from serum or the tibial microenvironment, collagen mimetics did not inhibit MSC adhesion, as was observed with RGD, however neither did they enhance adhesion. Given that activation of collagen-selective integrins stimulates osteoblastic differentiation, we monitored osteocalcin secretion and alkaline phosphatase activity from MSCs adherent to DGEA or P15-coated disks. Both of these osteoblastic markers were upregulated by DGEA and P15, in the presence and absence of differentiation-inducing media. Finally, bone formation on HA tibial implants was increased by the collagen mimetics. Collectively these results suggest that collagen-mimetic peptides improve osseointegration of HA, most probably by stimulating osteoblastic differentiation, rather than adhesion, of MSCs.