下肢动脉缺血性患者假性高压的鉴别及临床意义

Objective To evaluate the diagnosis of and management for pseudo-high blood pressure in patients with lower limb ischemia. Methods From March 2006 to March 2007, 182 cases with lower limb ischemia were admitted, and they were divided into three groups. In group 1 pseudo-high blood pressure did not exist, in group 2, patients had pseudo-high blood pressure with ABI<1.3, in group 3, patients had pseudo-high blood pressure and with ABI≥1.3. ABI and TBI were compared with color Doppler, angiography, MRA and CTA. Results In all those 182 patients, there were 102(56.0%)cases having no pseudo-high blood pressure, and 27.5% with concomitant diabetes. Seventy-two cases(39.6%) had pseudo-high blood pressure (ABI<1.3) with 44.4% having diabetes. Eight cases (4.4%) (ABI≥ 1.3) manifested pseudo-high blood pressure with the ratio concomitant diabetes being 75%. Conclusions In diabetic patients with lower limb's ischemia there is increased ratio of pseudo-high blood pressure.     

臂丛加颈浅丛神经联合阻滞用于锁骨骨折内固定术的临床观察

目的：观察臂丛加颈浅丛神经联合阻滞用于锁骨骨折内固定术的临床效果。方法：随机将90例患者分为3组,Ⅰ组臂丛加颈浅丛神经联合阻滞;Ⅱ组臂丛神经阻滞;Ⅲ组颈浅丛神经阻滞。结果：Ⅰ组麻醉效果明显优于其他两组。结论：臂丛加颈浅丛神经联合阻滞用于锁骨骨折内固定术具有很好的临床效果。     

Obstetric lesions of the brachial plexus.

The few studies on prognosis of obstetric lesions of the brachial plexus that are not hampered by selection bias or a short follow-up suggest that functional impairment persists in 20-25% of cases, more than commonly thought. Electromyography (EMG), potentially useful for prognosis, is often considered of little value. Denervation in the first week of life has been interpreted as evidence of an antenatal lesion, but is the logical result of the short axonal length affected. EMG performed at close to the time of possible intervention (3 months) usually shows a discrepancy: motor unit potentials are seen in clinically paralyzed muscles. This can be explained in five ways: an overly pessimistic clinical examination; overestimation of EMG recruitment due to small muscle fibers; persistent fetal innervation; developmental apraxia; or misdirection, in which axons reach inappropriate muscles. Further research into the pathophysiology of obstetric lesions of the brachial plexus is needed to improve prognostication.     

Vascular endothelial dysfunction is associated with reversible myocardial perfusion defects in the absence of obstructive coronary artery disease

Background  The purpose of this study was to investigate whether endothelial dysfunction contributes to abnormal myocardial perfusion imaging (MPI) observed in patients without obstructive coronary artery disease (CAD). It is unclear whether reversible MPI defects detected in the absence of obstructive CAD represent underlying vascular pathology or are false-positive MPI results. Recent evidence suggests that coronary endothelial dysfunction might play a role in the pathogenesis of these defects. Methods and Results  We prospectively recruited 36 patients with chest discomfort, reversible abnormalities on MPI, and nonobstructive or absent CAD (stenosis <50% on coronary angiography). The control group (n = 55) consisted of patients with chest discomfort and similar cardiac risk factors but with normal MPI findings. Vascular endothelial function was assessed in the brachial artery by ultrasound as the response to hyperemia and reported as percent flow-mediated dilation (FMD). Response to sublingual nitroglycerin was used as an indicator of endothelium-independent vasodilation. The patients with abnormal MPI findings and nonobstructive CAD had a significantly lower FMD (9.0% ± 7.2%), indicating endothelial dysfunction, compared with those with similar risk factors and normal MPI findings (12% ± 5.2%) (P ± .03). Baseline brachial artery size and endothelium-independent dilation were similar between groups. On multivariate analysis, only endothelial dysfunction was predictive of reversible MPI defects. Conclusions  Patients with chest pain and reversible MPI defects but without obstructive CAD have lower FMD indicative of endothelial dysfunction, as compared with similar patients with normal MPI findings. The possibility of a causal link between reversible MPI defects and endothelial dysfunction needs further exploration. Dr Soman was funded by the Herbert J. Levine Foundation Fellowship in Cardiovascular Medicine at Tufts-New England Medical Center and the Kos Pharmaceutical Fellowship in Preventive Cardiology during the course of this project.     

母体神经移植桥接健侧患臂丛治疗小儿难治性产瘫的实验研究

目的:为臂丛根性撕脱伤的治疗提供一种新的有效手术方法。方法:将实验动物按手术方式分组如下,A组:母鼠提供的的神经移植体一端与子鼠健侧臂丛上干行端侧吻合,另一端与患侧已切断的锁骨下肌皮神经远端行端端吻合。B组:母鼠提供的神经移植体一端与子鼠健侧臂丛上干行端侧吻合,另一端与患侧已切断的锁骨上颈6远端行端端吻合。C组:母鼠提供的神经移植体桥接于子鼠患侧膈神经与锁骨下肌皮神经之间。D组:子鼠患侧膈神经直接与锁骨上颈6远端行端端吻合。术后采用电生理学、组织学及肌肉功能检测等指标定期进行各组疗效评价。结果:A组和D组术后肱二头肌的恢复无明显差异,但明显优于B组和C组。结论:A组,即该实验设计的手术方法与D组,即目前被公认为最好的膈神经移位的疗效相当。     

Transbrachial insertion of an intra-aortic balloon pump for complex coronary angioplasty.

Transfemoral insertion of intra-aortic balloon pump (IABP) for hemodynamic support is a useful adjunct in patients undergoing complex percutaneous revascularization procedures. However, this approach is not always possible, particularly in patients with severe occlusive peripheral vascular disease. We describe the first reported case of insertion of IABP through the brachial artery.     

大鼠臂丛神经根生物力学特性的实验研究

目的 从生物力学角度观察大鼠臂丛C5～T1各神经根之间生物力学特性的差异。方法采用Wistar大鼠20只，暴露C5～T1神经根，进行在体轴向拉伸测试，记录一系列载荷—延长量；应用冰冻切片和图像分析技术测出各神经根初始横断面积，经计算求出各神经根一系列应力—应变值，再绘制出各神经根的应力—应变关系曲线，在曲线上分析神经根的各项生物力学性能指标。结果 ①大鼠臂丛C5～T1神经根应力—应变关系曲线与其他外周神经相似，但在定量上存在较大差异。②各神经根的最大延长率为50％～70％。弹性度为30％～50％，其中以C7神经根为最大，且C7神经根的强度、弹力极限也高于其他神经根。③各神经根的最大张力为250～500g，C5～7神经根最大张力与初始面积具有正相关性，C8、T1两者关系无显著性，且C5～7神经根最大应力、应变均高于C8、T1神经根。结论 大鼠臂丛神经根的生物力学特性存在明显差异，C5～7与C8、T1神经根解剖结构上差异及G与其他神经根在抗张性结构基础上的差异有待进一步研究。     

Magnetic resonance evaluation of cervical nerve root avulsion injury

Cervical nerve root avulsion is hard to diagnose with cervical myelography even in combination with computed tomographic scanning. Although magnetic resonance imaging may not demonstrate a root avulsion, it can demonstrate the sequelae of traumatic injury, such as pseudomeningoceles or displacement of the spinal cord, contralateral to the avulsed root. The findings in three different patients are presented and discussed.     

踝肱指数对老年高血压患者肾脏微血管并发症的预测价值

目的 探讨踝肱指数(ABI)与老年高血压患者肾脏微血管并发症的关系.方法 对2009年3月 —2012年8月于本院诊治并行ABI测定的378例老年高血压患者的病史资料及检查结果进行回顾分析.采用Logistic回归分析ABI与老年高血压患者肾脏微血管并发症的关系.结果 254例患者ABI在正常范围,ABI≤0.9患者121例,检出率32.0％; ABI＞1.3患者3例.Logistic分析显示与ABI降低明显相关的因素是年龄、吸烟、高脂血症、糖尿病、冠心病和收缩压,ABI降低与高血压肾病明显相关.结论 老年高血压患者有较高的周围血管疾病(PAD)发生率,ABI可用于早期诊断PAD,亦可早期提示高血压患者肾脏损害.