肾上腺素损伤内皮致动脉血栓形成的实验研究

目的研究肾上腺素能否直接损伤血管内皮细胞（VEC）,引起血栓形成,为今后研究肾上腺素过度脱氨损伤VEC机制研究和研发特异性防护药物打下基础。方法将家兔分成3组,肾上腺素组、生理盐水组和依诺肝素组。通过插管于股动脉游离段分别注入肾上腺素-生理盐水液、生理盐水,依诺肝素-肾上腺素液,保留25min后,动脉插管连接生物信号记录系统,观察血压曲线,当曲线变为直线即为血栓堵塞形成,记录栓塞时间。取与药物接触的股动脉段做切片,观察血管内皮的病理变化。结果肾上腺素组（20．08±1．72）min的栓塞时间显著短于生理盐水组（56．55±4．39）min和依诺肝素组（53．73±5．06）min（P〈0．01）,生理盐水组栓塞时间与依诺肝素组无明显差别。形态学观察股动脉血管显示,生理盐水组内皮质完整、光滑;肾上腺素组断裂、脱落较严重;依诺肝素组较完整,局部表面粗糙。结论肾上腺素能够直接损伤VEC,导致动脉血栓形成。     

下肢动脉旁路移植术后人工血管闭塞的再手术治疗

目的 总结下肢动脉旁路移植术后人工血管闭塞的再手术治疗经验.方法 回顾性分析21例下肢动脉旁路移植术后人工血管闭塞患者再手术的治疗效果.结果 21例患者术后均获随访,随访时间6～36(12±3)个月.肢体存活率71.4%(15/21),截肢率28.6%(6/21),9例最后通过股深动脉供血的患者肢体全部存活.结论 下肢动脉旁路移植术后人工血管闭塞的主要原因是内膜增生或流人道及流出道的狭窄闭塞,再手术前应仔细分析闭塞原因以选择合适的手术方式.股深动脉重建对于人工血管闭塞的再手术治疗非常重要.

Abstract：

Objective To review reoperation on blood vessel prosthesis occlusion after arterial bypass graft in lower limbs. Method The treatment effect of 21 patients with reoperation on blood vessel prothesis occlusion after arterial bypass graft in lower limbs was analyzed retrospectively. Results All the cases were followed up 6-36 (12 ±3) months. The limb salvage rate was 71.4%(15/21) ,the amputation rate was 28.6% (6/21). All 9 limbs that underwent revascularization from deep femoral artery reserved. Conclusions Endomembrane hyperplasy, occlusion of the inflow and outflow tracts are the major reasons for the occlusion of blood vessel prosthesis after arterial bypass graft in lower limbs. Appropriate procedures should be based on careful consideration of the occlusion reasons. Profundaplasty is an effective therapy for those who are treated by reoperation on blood vessel prosthesis occlusion in lower limbs.     

Complicaciones tras el empleo del dispositivo de cierre arterial StarClose en punciones femorales

The StarClose^® arterial device (Abbot Vascular Devices, Abbot Laboratories, Redwood City, CA, USA) rapidly seals a femoral artery puncture by means of a nitinol clip in the adventitia of the artery. It is a safe and effective device, with advantages as regards manual compression, but is not free of complications. We present two cases with complications after using a StarClose^® vascular device.     

Aneurisma de la arteria umbilical

Umbilical artery aneurism is extremely uncommon and few cases have been reported in the literature. An umbilical artery aneurism is described in a 20-year-old patient with a 38-week pregnancy. After vaginal delivery of a stillborn neonate, a soft, rounded pseudocyst was found. Histopathological examination revealed the presence of an umbilical artery aneurism.     

指动脉逆行岛状皮瓣的解剖与临床应用

目的：观察应用指动脉逆行岛状皮瓣修复指端（指腹）皮肤软组织缺损的临床效果。方法：对28例指端（指腹）缺损的患者实行带指神经背侧支的指固有动脉逆行岛状皮瓣修复术。结果：28例皮瓣全部成活,术后随访3～6个月,手指功能恢复良好。结论：指动脉逆行岛状皮瓣修复术操作简便,术后效果好,是修复指端（指腹）皮瓣软组织缺损的首选手术方法。     

Predicción de anemia fetal por isoinmunización tras transfusiones intrauterinas. Revisión de los casos tratados en nuestra unidad

Objetive

Evaluate the intrauterine blood transfusions performed in fetuses with anemia due to red blood cell alloimmunization in our unit and the detection rate of the middle cerebral artery Doppler to predict anemia after the first transfusion.

Material and methods

We performed 53 intrauterine blood transfusions in 15 patients with red blood cell alloimmunization. We analyze the characteristics of the cases and the value of the middle cerebral artery Doppler to predict fetal anemia.

Results

The detection rate of fetal anemia with the peak systolic velocity Doppler in the middle cerebral artery was 85% after the first transfusion and 72% after the second or more. There were no false positive results of the test in our series.

Conclusions

Doppler evaluation of the middle cerebral artery as predictor of fetal anemia has a lower detection rate after consecutive transfusions.     

冠脉舒对冠心病患者冠状动脉的扩张作用--32例彩色多普勒观察

目的研究冠脉舒(丹参、葛根、川芎煎剂)对冠心病心绞痛患者冠状动脉的扩张作用.方法采用彩色多普勒系统显示治疗前后一小时的左冠状动脉主干、左右颈总动脉的内径、血液流速.结果治疗组(n=32)左冠状动脉主干、左右颈总动脉内径、流速均较服药前增加(P＜0.05).对照组(n=41)治疗前后其参数变化无显著差异(P＞0.05).治疗组治疗前后参数变化值较对照组亦有显著差异(P＜0.05).结论冠脉舒能增加冠心病患者的冠脉循环量,可能对冠心病心绞痛的治疗有益,并提示冠脉舒对周围血管可能有扩张作用.同时,本文在彩色多普勒观察药物作用的方法上进行了有益的实践.     

Pseudoaneurysma der A. hepatica – eine seltene Komplikation nach orthotoper Lebertransplantation

INTRODUCTION: Pseudoaneurysm of the hepatic artery is a rare complication of liver transplantation, the most common cause of which--apart from technical surgical problems--is an infection. The most common symptoms are rupture and hemorrhage. METHOD: The present case report describes an asymptomatic pseudoaneurysm of the hepatic artery following liver transplantation, and its treatment. RESULTS: In this patient, an pseudoaneurysm involving an eroded branch of the hepatic artery was found. Surgical treatment consisted in the excision of the aneurysm and oversewing of the branch of the hepatic artery. CONCLUSION: The potential for rupture and hemorrhage makes surgical intervention mandatory even in asympotomatic patients with pseudoaneurysm of the hepatic artery. The surgical procedure depends on the local situation and the time elapsed since transplantation. Preservation or reconstruction of the arterial perfusion is essential.     

Flottierender Thrombus der Arteria carotis interna als seltene Komplikation bei einem ovariellen Hyperstimulationssyndrom nach In-vitro-Fertilisation/Embryotransfer

Zusammenfassung. Berichtet wird über eine 33 j?hrige Frau mit einem ovariellen Hyperstimulationssyndrom nach Behandlung mit FSH/HCG für eine In-vitro-Fertilisation, die eine vorübergehende linksseitige Hemiparese entwickelte als Ursache eines flottierenden Thrombus im rechten Carotisbulbus. Durch die offene chirurgische Thrombektomie konnte die Wiederholung einer neurologischen Symptomatik verhindert werden.