游离腹壁浅动脉筋膜穿支皮瓣修复手部创面

目的 报告应用游离腹壁浅动脉筋膜穿支皮瓣修复手部创面的临床效果.方法 对10例手部皮肤软组织缺损的患者,采用游离腹壁浅动脉筋膜穿支皮瓣进行修复,皮瓣切取面积为8cm×6cm～16cm×9cm.结果 术后1例皮瓣发生血管危象,经探查后存活,其余皮瓣全部顺利存活.经4～12个月的随访,皮瓣质地、外形优良,手功能恢复满意.术后供区伤口均Ⅰ期愈合,外形满意.结论 应用游离腹壁浅动脉筋膜穿支皮瓣可以一期修复创面,供区损伤小,是修复手部创面的理想选择.     

Foreign body sensation: A rare case of dysphagia lusoria in a healthy female

Dysphagia lusoria is a rare disease due to an aberrant right subclavian artery that passes posteriorly between the esophagus and the spine. David Bayford coined the term itself meaning "freak or jest of nature" in 1761 describing a case in which the patient had long term dysphagia that eventually led to death. Most cases of dysphagia are due to an aberrant right subclavian artery running posterior to and causing esophageal compression, but only 20-40% of aberrant arteries actually lead to trachea-esophageal symptoms, including dysphagia. The majority of patients with an aberrant right subclavian artery are asymptomatic. Treatment for dysphagia lusoria varies depending on the severity of the symptoms. Dietary modifications are recommended in patients with mild to moderate symptoms while vascular reconstruction is necessary for patients with severe symptoms. We present a 44-year-old female who was diagnosed with dysphagia lusoria due to a right-sided aortic arch and aberrant left subclavian artery (ALSA) with aneurysmal dilation. Right aortic arch with ALSA is an uncommon arch anomaly, and only occurs in about 0.05% of the population. Prior case reports of dysphagia lusoria differ in that they did not report patients with an uncommon presentation of dysphagia lusoria with aneurysmal dilatation nor was the patient diagnosed in the emergency department.     

Disección aislada y espontánea de arterias viscerales

We present the cases of two men with isolated spontaneous dissection of visceral arteries diagnosed by multidetector CT. In the first patient, dissection of the celiac trunk was associated with periarterial changes. In the second patient, dissection of the superior mesenteric artery was associated with stenosis at the root of the celiac trunk. Both patients presented with acute pain, which was more intense and longer lasting in the first patient. Aortic dissection was suspected clinically in both patients.     

The arterial supply of the human spinal cord: A new approach to the arteria radicularis magna of Adamkiewicz

Summary The arteria radicularis magna (Adamkiewicz's artery) was studied in 30 human spinal cords after arterial injection. The artery was present in all cases, between T 8 and L 2, and was identified by its diameter and position. The arteria radicularis magna was the main blood supply to the lowest region of the spinal cord. In one out of three cases it accompanied the ventral root at T9, and in 80% of the cases studied it was found on the left side. The arteria radicularis magna had a posterior component in 63% of the cases. We did not observe specific radiculo-medullary arteries in the conus medullaris region.     

Beidseitiger Verschluß der Arteria carotis interna mit binasalem Gesichtsfeldausfall und partieller Opticusatrophie

Zusammenfassung Es wird über einen Fall von doppelseitigem Carotisinterna-Verschluß berichtet, der einen binasalen quadrantenförmigen Gesichtsfeldausfall mit partieller Opticusatrophie als einzige Symptome hatte. Nach einer Übersicht der Literatur über Verschlüsse der Arteriae carotides internae und ihrer Kollateralverbindungen folgt eine Diskussion über die möglichen pathogenetischen Mechanismen.     

彩色多普勒超声诊断锁骨下动脉盗血综合征17例探讨

目的 探讨彩色多普勒超声诊断锁骨下动脉盗血综合征的应用效果.方法 超声检查17例经血管造影或数字减影血管造影确诊的锁骨下动脉盗血综合征患者,观测椎动脉频谱图的速度、形态、方向,对锁骨下动脉狭窄程度进行判断.结果 17例锁骨下动脉盗血综合征患者超声检查均作出正确诊断,左侧盗血者11例,右侧盗血者6例;锁骨下动脉狭窄程度:轻度4例,中度5例,重度8例,其椎动脉频谱形态分别为有切迹、正负双向及反向.结论 应用彩色多普勒超声可准确诊断锁骨下动脉盗血综合征,并能估测锁骨下动脉起始部狭窄程度.     

初诊Ⅱ型糖尿病内皮功能与阴茎深动脉血流动力学关系的研究

目的 :应用彩色多普勒超声探讨初诊 型糖尿病患者的血管内皮功能与阴茎深动脉血流动力学间的关系。方法 :对 17例初诊 型男性糖尿病患者测量其内皮舒张功能及阴茎勃起前后阴茎深动脉的内径及血流动力学参数 ,并与正常对照组进行比较。结果 :1.初诊 型糖尿病患者的内皮功能与正常对照组相比有统计学意义 (P<0 .0 5 ) ;2 .初诊 型糖尿病患者勃起状态时阴茎深动脉的阻力指数 (RI)、舒张期血流速度 (Vd)与正常对照组相比有显著的统计学意义 (P<0 .0 5 ) ;3.相关性分析显示 :内皮血管舒张功能与阴茎深动脉的阻力指数呈正相关 ,与舒张期血流速度呈负相关。结论 :初诊 型糖尿病患者已存在血管内皮功能的损伤 ,可造成阴茎深动脉血流动力学变化。     

颈动脉内-中膜厚度与冠状动脉病变程度的相关性研究

目的探讨颈动脉内-中膜厚度（IMT）与冠状动脉病变程度的相关性。方法选取本院自2012年1月-2013年1月收治的136例经冠状动脉造影证实为冠心病的患者为研究对象（冠心病组。n=136）,并按照病变程度分为单支病变组（n=38）、双支病变组（n=52）和多支病变组（n=46）,选取同期冠脉造影正常的100例患者为对照组（非冠心病组,n=100）。所有患者均行双侧颈动脉超声检查,记录颈动脉IMT、斑块Crouse积分以及冠状动脉Gemini积分,分析各指标间的相关性。结果冠心病组IMT[（5．12±3．73）mmVS（1．14±0．22）mm]、斑块Crouse积分[（1．27±0．34）分VS（0．75±0．16）分]以及冠状动脉Gensini积多[（21．82±9．25）分Vs（0．00±O．00）分]均明显高于非冠心病组,差异均有统计学意义（均P〈0．05）;多支病变组颈动脉IMT、斑块Crouse积分以及冠状动脉Gensini积分均明显高于单支病变组和双支病变组,差异均有统计学意义（均P〈0．05）;相关性分析显示冠状动脉Gensini积分与IMT（r=0．76）和斑块Crouse积分（r=0．66）均呈正相关,差异均有统计学意义（均P〈0．05）。结论颈动脉内-中膜厚度与冠状动脉病变程度高度相关,及时进行颈动脉超声检查可以早期发现冠状动脉病变。     

经桡动脉冠脉介入诊疗后两种压迫器止血效果的比较

目的:比较经桡动脉冠脉介入术后使用螺旋式和气囊式两种桡动脉压迫器的止血效果。方法 :随机抽取近2年来经桡动脉途径行冠状动脉介入术的400例患者,螺旋压迫器组、气囊压迫器组各200例,对单纯行冠脉造影者使用5F动脉鞘,而行PCI者根据情况使用6F动脉鞘。对两组患者的初次止血的成功率、肢体肿胀程度以及并发症的发生率进行比较。结果 :两组患者初次止血成功率及手掌肿胀程度并无差异,螺旋式压迫器组前臂肿胀的发生率高于气囊式压迫器组,但其皮肤并发症的发生率低于气囊式压迫器组。结论 :两种压迫器均可获得满意的止血效果,但在并发症的发生方面各具优势和不足,尚有改进的空间。     

肝动脉节段性化疗栓塞治疗原发性肝癌36例临床分析

目的探讨经动脉化疗栓塞治疗原发性肝癌的临床途径、疗效及安全性。方法将72例原发性肝癌患者随机分为观察组和对照组,各36例。观察组实施节段性化疗栓塞治疗,对照组采用非节段化疗栓塞治疗。结果观察组总有效率为94.44%,对照组总有效率为66.67%,两组比较差异有高度统计学意义（P〈0.01）。两组1年期生存率比较差异有高度统计学意义（χ2=6.883,P〈0.01）,2年期生存率比较差异无统计学意义（χ2=1.143,P〉0.05）。治疗过程中,所有患者均出现程度不等的术后发热、右上腹疼痛、恶心、呕吐等,经3～7 d后逐渐消失。其中,观察组使用杜冷丁者5例（13.89%）,对照组24例（66.67%）。结论经肝动脉节段性化疗栓塞是治疗原发性肝癌的一种安全可靠、疗效明显的手段,其疗效及安全性明显优于非节段化疗栓塞,值得临床推广。