Abdominal aortic aneurysm: Treatment options, image visualizations and follow-up procedures

Abdominal aortic aneurysm is a common vascular disease that affects elderly population. Open surgical repair is regarded as the gold standard technique for treatment of abdominal aortic aneurysm, however, endovascular aneurysm repair has rapidly expanded since its first introduction in 1990s. As a less invasive technique, endovascular aneurysm repair has been confirmed to be an effective alternative to open surgical repair, especially in patients with co-morbid conditions. Computed tomography (CT) angiography is currently the preferred imaging modality for both preoperative planning and post-operative follow-up. 2D CT images are complemented by a number of 3D reconstructions which enhance the diagnostic applications of CT angiography in both planning and follow-up of endovascular repair. CT has the disadvantage of high cummulative radiation dose, of particular concern in younger patients, since patients require regular imaging follow-ups after endovascular repair, thus, exposing patients to repeated radiation exposure for life. There is a trend to change from CT to ultrasound surveillance of endovascular aneurysm repair. Medical image visualizations demonstrate excellent morphological assessment of aneurysm and stent-grafts, but fail to provide hemodynamic changes caused by the complex stent-graft device that is implanted into the aorta. This article reviews the treatment options of abdominal aortic aneurysm, various image visualization tools, and follow-up procedures with use of different modalities including both imaging and computational fluid dynamics methods. Future directions to improve treatment outcomes in the follow-up of endovascular aneurysm repair are outlined.     

25例过量受照人员的远期辐射医学效应

目的 探讨过量受照人员的远期健康效应.方法 对25例受照剂量为0.10～0.33 Gy的人员,进行照后32 ～41年的医学随访.观察临床表现、眼晶状体、细胞遗传学指标、免疫功能、内分泌功能等指标的变化.结果 受照者无力型神经衰弱症状发生率高.2例分别患肝癌、食管癌;7例出现晶状体后囊下点状混浊,1例疑似放射性白内障;外周血淋巴细胞染色体畸变率和微核率显著高于对照组(x2=8.88、8.71、40.60、45.63,P＜0.05);受照组血清IgG平均值显著高于对照组(t =2.16,P＜0.05),IgM平均值显著低于对照组(t=2.03,P＜0.05);受照组血清三碘甲状腺原氨酸(T3)、甲状腺素(T.)、促甲状腺素( TSH)平均值均在正常范围,但显著低于对照组(t=2.40、3.54、2.13,P＜0.05).结论 过量照射对晶状体、免疫系统、细胞遗传学指标存在一定的影响,观察过量受照人员的远期医学效应有重要意义.     

跟进式干预对提高空巢老人家庭伤害防护能力的作用

目的：提高空巢老人家庭伤害的防护能力,降低家庭伤害发生率,设计跟进式干预的伤害连续性管理方案,探索其有效性和可行性。方法：采用随机对照临床试验研究,选择我市2个居委会空巢老人各36名,分别设定为观察组和对照组,观察组采取跟进式干预方案,对照组采取传统干预方案,使用自行设计的量表在干预6个月时和停止干预电话随访6个月时分别对两组的家庭伤害防护能力进行效果评价。结果：观察组空巢老人的家庭伤害防护能力优于对照组（P〈0.05）。结论：采用跟进式干预方式进行家庭伤害的连续性管理,有效提高了空巢老人的家庭伤害防护能力,切实可行,值得推广,但空巢老人的家庭环境改造方面,还需要政府在政策和资金上大力支持。     

A long-term follow-up study of juvenile aneurysm patients

Summary The long-term outcome in 26 patients following operation of intracranial saccular aneurysms before the age of twenty is presented. The duration of follow-up ranged from 4 to 33 years (mean 14 years). The oldest patient is now 51 years old. 19 patients (73%) made a complete or good recovery with resumption of normal life. Only one patient was severely disabled and dependent for daily support. Aspects of social outcome such as working conditions and family relationships were encouraging. No association between presence of vasospasm in the acute phase of the disease and the long-term outcome was demonstrated. In one case rupture of a previously undetected aneurysm had occurred during the followed-up period.     

产后抑郁症的筛选和抑郁状况的追踪

目的了解妇女产后4～6周抑郁症的发病情况及经过8～12个月后其抑郁状况的恢复情况及其影响因素。方法用爱丁堡产后抑郁量表(EPDS)对352例4～6周前生产的妇女进行产后抑郁症的筛查,并对产后抑郁症筛查阳性者8～12月内进行追踪,再次用EPDS和母亲一般情况调查表进行评定。结果产后4～6周抑郁症的筛选阳性率为15．9%,筛选阳性者在产后8～12月仍有41%的妇女保持抑郁状态。夫妻感情、与父母的关系、孩子的抚养及是否恢复工作是影响产后妇女抑郁状况的主要因素。结论产后抑郁症的发生率较高,夫妻感情和睦、与父母的关系融洽是产后抑郁症的保护性因素。     

Sarkome des gastrointestinaltraktes

Zusammenfassung Von 1970–1980 wurden 15 Patienten mit gastrointestinalen Sarkomen operiert. Vier weitere Patienten mit dieser Diagnose mußten nach histologischer Reklassifizierung aus dieser Gruppe ausgeschlossen werden. In 10 Fällen wurde mit kurativer Intention operiert. Bei 3 Patienten lagen initial Fernmetastasen vor, bei 6 weiteren traten sic später auf. Das Tumorstadium TNMG erwies sich nur beim Lymphknotenstatus als prognostisch aussagekräftig. Acht Patienten verstarben am progredienten Tumorleiden, 4 leben tumorfrei seit 20–97 Monaten. Ein Patient mit Lebermetastasen ist 32 Monate nach Chemotherapie in einer kompletten Remission. Es ergab sich eine 5-Jahres-Überlebensrate von 28%. Die radikale Tumorentfernung mit Lymphadenektomie wird empfohlen, bei Auftreten von Metastasen eine Chemotherapie.

---

Sarcomas of the gastrointestinal tract

Summary From 1970–1988 15 patients were operated on gastrointestinal sarcomas. Four more patients with this diagnosis had to be excluded after histological reclassification. A resection with curative intention was possible in 10 cases. Three patients initially had distant metastases, in 6 patients they appeared postoperatively. Regarding prognosis the TNMG-system proved to be useful only concerning lymph nodes. Eight patients died because of tumor progression, four have no evidence of disease 20–97 months postoperatively. One patient with liver metastases has a complete remission 32 months after chemotherapy. We found a 5-year-survival rate of 28%. Radical tumor resection and lymphadenectomy is recommended, distant metastases should be treated by chemotherapy.

Wir danken Herrn Prof. Dr. S. Schröder aus dem Institut für Pathologic der Universitatsklinik Hamburg für die Unterstützung bei der histologischen Reklassifizierung     

分化型甲状腺癌术后随访中停用左旋甲状腺素2周的临床价值

目的观察分化型甲状腺癌(DTC)术后停用左旋甲状腺素(l-T_4)2周 TSH 水平变化及判断 DTC 残留、复发和转移甲状腺球蛋白(Tg)的界定值。方法甲状腺次全切或全切术后用(131)~I去除治疗,服用 l-T_4时,Tg相似文献   

严重急性呼吸综合征患者肺内残留病变CT表现的随访观察

目的 探讨严重急件呼吸综合征（SARS）患者临床治疗后，CT复查肺内残留病变的动态变化情况。方法 对124例治疗后的SARS患者进行CT复查随访，失访13例，资料完整111例，对平均病程第3、6、12及18个月行螺旋CT检杏的结果进行对比分析，总结其影像动态变化的特征。结果 病程18个月内，相继有70例（占63．1％）患者肺内CT表现恢复止常。6、12、18个月时CT主要征象：（1）磨玻璃样病变残留率分别为33．3％（37／111）、24．3％（27／111）、20．7％（23／111）。（2）小叶间隔或小叶内间质增厚残留率分别为37．8％（42／111）、28．8％（32／111）、25．2％（28／111）。以上2种主要病变在随访期内的总体变化经对比分析X^2检验，差异有统计学意义（P〈0．01）。（3）胸膜下弧线影15例，随访期内病变有不同程度的吸收，但无一例病变消失。（4）不规则纤维条索影18个月时残留率17．1％（19／111）。少见征象：（1）实变病灶1例，病程第12个月完全吸收。（2）空洞病灶2例，1例于病程第12个月基本吸收，1例随访期内末完全吸收。（3）牵拉性支气管扩张1例，随访期内无明显变化。（4）小结节灶3例，1例病程第12个月基本吸收，2例无明显变化。结论 病程第18个月SARS患者肺内磨玻璃样病变残留率为20．7％。17．1％的患者残留局限性肺间质纤维化改变。对肺内残留磨玻璃样病变的患者继续定期随访间隔6～12个月为宜，其他患者可以延长随访间隔时间至12个月以上。