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31.
目的探讨颈内动脉巨大动脉瘤的特点和手术策略。方法回顾性分析48例颈内动脉大型和巨大型动脉瘤的手术经验。手术均采用翼点人路,床突旁动脉瘤病例预先暴露颈部颈内动脉以备临时阻断。从硬脑膜内磨除前床突、视神经管上壁以及外侧嵴,以显露动脉瘤的近侧角。术中采用逆向抽吸法使动脉瘤塌陷,如动脉瘤内含机化血栓,则在临时阻断后切开瘤体,用CUSA和取瘤镊去除瘤内血栓,再将动脉瘤夹闭并达到视神经减压的目的。术中监测脑电图和体感诱发电位,并采用术中超声多普勒检查动脉血流。结果46例动脉瘤直接夹闭,2例海绵窦段动脉瘤行动脉瘤孤立并分别做颞浅动脉-大脑中动脉和大隐静脉移植颈外动脉-大脑中动脉搭桥手术。43例术后行DSA检查,绝大多数动脉瘤夹闭满意。按GOS评分术后良好为41例(85.4%),差为5例,死亡2例。结论充分显露、合理应用临时阻断技术、有效的动脉瘤减压,以及术中应用电生理监测和超声多普勒检查等辅助措施,能够取得动脉瘤的满意夹闭。 相似文献
32.
Kiyoaki Takaba Masaki Aota Hiroyuki Koike Yutaka Konishi 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2004,52(4):194-197
Aneurysm of the innominate artery is uncommon compared with other peripheral aneurysms, and holds the potential for rupture,
embolization, or thrombosis as well as various complications caused by compression to the adjacent structures. The most effective
treatment for this condition is surgical resection, but the earlier reports described high mortality rates. We report the
case of an 83-year-old asymptomatic woman with an aneurysm in the innominate artery, which was successfully resected and repaired
with the use of modern surgical techniques of hypothermic circulatory arrest and selective cerebral perfusion. Aggressive
surgical intervention should be employed despite the fact that a patients is asymptomatic. 相似文献
33.
低温体外循环下手术治疗主动窦瘤破裂16例,采用右房切口1例,右室流出道切口11例,窦瘤破入腔和主动脉根部双切口4例。单纯窦瘤破口修补2例;双头垫片针窦瘤基部与空间隔踬同并列间断褥式缝合修补3例; 相似文献
34.
T. Sakaki T. Matsuyama T. Yabuno H. Hashimoto Sh Kurokawa Sh Kawaguchi T. Morimoto 《Acta neurochirurgica》1995,133(1-2):17-21
Summary The authors describe an approach through the temporal horn of the lateral ventricle which proved to be useful for clipping of a large dorsal type basilar bifurcation aneurysms. It facilitates the preservation of the perforating arteries behind the aneurysm, because it gives sufficient working space to move the aneurysm dome. Furthermore this approach avoids many of the disadvantages of other approaches, especially the risk of iatrogenic injuries of the Sylvian or Labe's vein. 相似文献
35.
Lower level of serum potassium and higher level of C-reactive protein as an independent risk factor for giant aneurysms in Kawasaki disease 总被引:7,自引:0,他引:7
Giant aneurysms are the most serious issue of patients with Kawasaki disease (KD). To clarify risk factors for these giant aneurysms, we conducted a matched case-control study. Among the patients reported in nationwide surveys, 117 patients with giant aneurysms had an unequivocal new diagnosis and presented at the treatment center within 9 d of illness. We obtained clinical information on admission of about 69 patients (case) from the treatment centers. One control was selected for each case, an age- and sex-matched patient without coronary involvement, reported from the same treatment center at about the same time as the case, and we obtained the same clinical information about controls. Fourteen variables were analysed with a conditional logistic regression model: body temperature, hematocrit, hemoglobin, numbers of leukocyte and platelets, concentrations of serum albumin, globulin, total cholesterol, sodium, potassium and chloride, erythrocyte sedimentation rate, C-reactive protein and alanine aminotransferase activity. After adjustment for age, duration of illness before admission and use of intravenous gamma globulin therapy, C-reactive protein [odds ratio (OR) = 1.142, 95% confidence interval (CI) 1.054-1.237], alanine aminotransferase activity (OR = 1.008, 95% CI 1.002-1.014), serum sodium concentration (OR = 0.877, 95% CI 0.770-0.999) and serum potassium concentration (OR = 0.319, 95% CI 0.124-0.822) were significantly related to the risk for giant aneurysms. Further analyses with these four explanatory variables revealed that C-reactive protein (OR = 1.159, 95% CI 1.022-1.315) and serum potassium concentration (OR = 0.222, 95% CI 0.052-0.948) met the significant level. Thus, the values for serum C-reactive protein and potassium are independent risk factors for the development of the giant aneurysms of Kawasaki disease. 相似文献
36.
Sylvie Destian M.D. Howard Tung M.D. Richard Gray M.D. David R. Hinton M.D. John Day M.D. Takanori Fukushima M.D. 《Surgical neurology》1994,41(6):472-476
Infectious intracavernous carotid artery aneurysms usually present with ophthalmoplegia and/or signs of cavernous sinus thrombosis. We report an unusual case in which a patient with AIDS presented with intractable epistaxis secondary to rupture of a giant infectious intra-cavernous carotid artery aneurysm. Culture of the aneurysm grew mycobacterium avium intracellulare (MAI). The patient was treated successfully by excision of the aneurysm and reconstruction of the internal carotid artery with a saphenous vein interposition graft. 相似文献
37.
Relationships between Activators and Inhibitors of Plasminogen, and the Progression of Small Abdominal Aortic Aneurysms 总被引:1,自引:0,他引:1
J. S. Lindholt B. Jrgensen G. -P. Shi E. W. Henneberg 《European journal of vascular and endovascular surgery》2003,25(6):546-551
OBJECTIVE: plasmin is a common activator of the known proteolytic systems involved in the aneurysmal degradation, and is reported to be associated with the expansion of abdominal aortic aneurysms (AAA). The aim of this study was to study the activating pathways of plasminogen as predictors of the progression of AAA. MATERIALS AND METHODS: one hundred and twelve of 122 male patients with a small AAA (def.: +3cm) were interviewed, examined, had blood samples taken at diagnosis, and scanned annually for 1-5 years (mean 3.5 years), and referred for surgery if the AAA exceeded 5cm in diameter.A random sample of 70 of the 112 cases had plasma levels of urokinase-like-plasminogen activator (uPA), tissue-type-plasminogen activator (tPA), plasminogen-activator-inhibitor-1 (PAI-1), macrophage inhibiting factor (MIF), tumour-growth-factor-beta1 (TGF-beta1), homocysteine, and serum levels of IgA-antibodies against Chlamydia pneumoniae (IgA-CP) and Cotinine (a nicotine metabolite) measured. Spearmans correlation analysis was used for statistics. RESULTS: the annual expansion rate correlated positively with tPA, IgA-CP and S-Cotinine; r =0.37 (p=0.002), 0.29 (p=0.006) and 0.24 (p=0.038), while PAI1, uPA, TGF-beta1, homocysteine, and MIF did not. S-Cotinine did also correlate positively with tPA, r=0.24 (p=0.049). CONCLUSION: the aortic matrix degradation in AAA may be partly caused by an activation of plasminogen by tPA, but apparently not by uPA, which usually dominates matrix degradation. Smoking seems to be a factor for this pathway, while the pathways of IgA-CP and MIF, a new marker of aneurysmal progression, seem different. The latter observations suggest that other proteolytic pathways are involved in the aortic wall degradation in AAA. 相似文献
38.
H. L. Journée A. C. van Bruggen J. J. van der Meer A. B. de Jonge J. J. A. Mooij 《Medical & biological engineering & computing》1995,33(2):140-144
The recording of sounds over the oribt of the eye has been found to be useful in the detection of intracranial aneurysms.
A hydrophone for auscultation over the eye has been developed and is tested under controlled conditions. The tests consist
of measurement over the eyes in three healthy volunteers at rest, during voluntary breathing, during eyeball movements and
during sustained orbicular muscular contractions. Furthermore, measurements are performed at the side of the nose. Major features
of the hydrophonic transducer are high sensitivity to physiological sounds and a high degree of insensitivity to environmental
sounds propagated through the air. It can be concluded that the hydrophone may be useful for the early detection of intracranial
aneurysms and also for apnoea detection. 相似文献
39.
MICHÈLE COUTARD MARY OSBORNE-PELLEGRIN 《International journal of experimental pathology》1996,77(2):53-62
Microscopic aneurysmal-like structures (ALS) develop spontaneously in the convoluted rat testicular artery and have been previously proposed as a model relevant to cerebral aneurysms. The effect of defects in connective tissue fibres on ALS formation was investigated by microscopy using two approaches: (i) the study of the effect of β-aminopropionitrile (BAPN), an inhibitor of the cross-linking of elastic and collagen fibres, on the incidence, size and morphology of ALS in spontaneously hypertensive rats (SHR) and their normotensive controls (WKY). The straight spermatic artery was studied for comparison. (ii) The determination of the incidence of spontaneous ALS in Brown Norway (BN) and Long Evans (LE) rats which are highly susceptible (BN) or resistant (LE) to the spontaneous rupture of the arterial internal elastic lamina. (i) BAPN increased the number and size of ALS in SHR and WKY rats and had no effect on the straight spermatic artery and (ii) ALS were more numerous and of greater size in BN than in LE rats. Taken together, these results show that defective connective tissue fibres may favour the formation and induce the enlargement of aneurysmal-like structures. By analogy, these data suggest that a lack of connective tissue fibre integrity may be of importance in cerebral aneurysm formation and development. 相似文献
40.
S E Harding G Vescovo S M Jones G Bennett M Yacoub P A Poole-Wilson 《The Journal of pathology》1989,159(3):191-196
Isolated single myocytes were prepared from myocardium of developing ventricular aneurysms and from myocardium within the scar of chronic ventricular aneurysms. The morphology and function of the individual cells were compared. The cells from developing aneurysms were rod-shaped, with a distinct sarcomeric structure, but did not contract even in the presence of high calcium concentrations. The sarcomere length was significantly higher than that of cells from chronic aneurysms and approached the theoretical point at which no contraction can occur. Cells from chronic aneurysms were either rod-shaped and contractile, or rounded due to hypercontracture of the myofilaments. Electron microscopy of cells from developing aneurysms confirmed the presence of elongated sarcomeres, a loss of the actin-myosin interdigitation, and damage to the contractile proteins which was particularly evident in the thin filaments. Cells with similar characteristics have also been isolated from a ruptured, ischaemic papillary muscle. These changes, which are due either to ischaemia or to overstretching of cells, may account for the weakness of the wall of developing aneurysms and be a cause of rupture or enlargement. 相似文献