16层螺旋CT静脉血管成像对脑静脉窦血栓形成诊断价值的初步探讨

目的 探讨16层螺旋CT静脉血管成像对脑静脉窦血栓形成的诊断价值.方法 回顾分析6例诊断为脑静脉窦血栓病例的16层螺旋CT表现特点.结果 2例可见高密度索条征,2例可见脑组织水肿、局灶性静脉性梗塞,2例脑室扩大,1例脑室缩小,1例脑血循环时间延长.6例均可见Delta征,CT静脉血管成像三维重建均可见静脉窦内充盈缺损.结论 16层螺旋CT静脉血管成像是诊断脑静脉窦血栓形成的可靠、有效的检查方法.     

副鼻窦低剂量螺旋CT扫描的临床研究

目的：探讨副鼻窦低剂量螺旋CT扫描的最佳条件。材料与方法：对60例患者的副鼻窦均采取冠状位螺旋CT扫描，扫描条件分别为：120KV，250mA、200mA、100mA、50mA、25mA，5mm层厚，5mm间隔，扫描时问为1s。将扫描的图像由5位有一定经验的CT室医师、技师分别对影像质量进行盲法评分，分析在保证影像质量基础上采用低剂量的最佳低扫描条件。结果：选择扫描时间为1s，管电压120kV，电流50mA，5mm层厚、5mm间隔作为低剂量扫描的最佳扫描条件。结论：120kV，50mA低剂量扫描在保证副鼻窦病变的影像质量的前提条件下，保护管球的同时大大的降低了病人的照射剂量，达到双赢的目的。     

Endoscopic Approach for the Excision of Giant Cell Tumor of Tendon Sheath Involving the Hindfoot: A Case Report

Giant cell tumor of tendon sheath (GCT-TS) is an often benign neoplasm that is relatively uncommon in the foot and ankle when compared to the upper extremities. Magnetic resonance imaging aids in characterizing the lesion, but diagnosis is confirmed with biopsy. Surgical excision is the preferred treatment. There is a lack of studies examining the long-term outcomes of endoscopic excision of GCT-TS, especially lesions found in the foot and ankle. The present study describes a case of a 42-year-old male with GCT-TS of the hindfoot treated with an endoscopic excision through a sinus tarsi approach. The patient was asymptomatic with no local signs of recurrence at the 67-month follow-up visit.     

Sorbalgon藻酸钙敷料在鼻内镜术后的应用

目的 :选择鼻内镜术后良好的鼻腔填塞材料。方法 :比较鼻内镜术后应用Sorbalgon藻酸钙敷料和凡士林纱条填塞鼻腔的止血效果及填塞后鼻腔局部反应情况。结果 :应用Sorbalgon藻酸钙敷料在鼻内镜术后填塞鼻腔的止血效果好 ;鼻腔疼痛及头痛程度轻 (P <0 0 1) ;抽取填塞物时鼻出血少 (P <0 0 1) ;术后鼻腔黏膜水肿反应轻 (P <0 0 5 )。结论 :Sorbalgon藻酸钙敷料是一种良好的鼻内镜术后鼻腔填塞止血材料     

主动脉窦瘤破裂的超声心动图诊断

目的评价主动脉窦瘤破裂(rupturedaorticsinusaneurysm,RASA)的超声心动图价值。方法复习文献,回顾性分析经手术证实的9例主动脉窦瘤的超声心动图特征。结果超声心动图可以准确显示窦瘤的形态、部位、破入心腔方向、血流动力学及并发症。结论超声心动图可于手术前及时、准确的诊断本病。     

DDIR Versus VVIR Pacing in Patients with Paroxysmal Atrial Tachyarrhythmias

Patients with sinus node dysfunction (SND) in particular those with tachycardia-bradycardia syndrome and patients undergoing atrioventricular nodal ablation procedures for refractory paroxysmal atrial tachyarrhythmias (PAT), are candidates for single chamber (VVIR mode) or dual chamber rate responsive (DDIR mode) systems. To evaluate the benefits and disadvantages of each pacing mode we retrospectively analyzed 33 patients with a history of frequent PAT who received a VVIR (22 patients); or a DDDR pacemaker (11 patients) programmed to the DDIR mode. The mean follow-up time was 25 and 18 months, respectively. Preimplant left atrial diameter was significantly smaller in the DDIR group. Chronic atrial fibrillation developed in 54% of the VVIR patients and 27% of the DDIR group, but this difference was not significant. Complications of patients with VVIR pacemakers included new mitral and tricuspid insufficiency, stroke, pacemaker inlolerance and aggravated congestive heart failure. Patients with DDIR pacemakers had a lower incidence of symptoms and complications. However, this group received more antiarrhythmic medication, required a closer follow-up, and their pacemakers needed frequent reprogramming. Our findings suggest that VVIR is a poor choice for patients with SND, congestive heart failure, and PAT, and that DDIR may be an acceptable alternative.     

The Heart Rate Response to Carotid Artery Massage in a Sample of Healthy Elderly People

Carotid artery massage was carried out in a cross-section of 95 healthy elderly subjects (51 men and 44 woman, mean age of 74 years) to assess the heart rate response and associated symptoms. These subjects were drawn from a larger group of randomly selected healthy elderly people living in Southampton. They had no history of myocardial infarction or stroke and were not taking any drugs that might enhance the carotid sinus reflex. A continuous distribution of response to carotid artery massage was seen with a median percent change in RR interval of 11.6% (IQR 22.9%); 66% had a percent change in RR interval of < 20%, 90% had a change of < 50%, and 9.5% a change of > 100%. Carotid sinus hypersensitivity (sinus arrest > 3 s) was found in 4 previously asymptomatic subjects; a prevalence of 4.2% (95% CI 1.2%–10.4%), and this was associated with dizziness in 2 of these 4 subjects. Dizziness also occurred in one other subject who had a change in RR interval of 178%, The definition of an abnormal carotid sinus reflex is arbitrary given the continuous RR interval response to carotid artery massage. In diagnosing carotid sinus syndrome, the RR interval response to carotid artery massage alone is not sufficient, as this maneuver must also reproduce the patient's presenting symptoms.     

Ventricular and Dual Chamber Pacing for Treatment of Carotid Sinus Syndrome

Thirty-nine consecutive patients with recurrent syncope and either cardioinhibitory or mixed type carotid sinus syndrome were studied to determine the efficacy of ventricular (VVI) pacing in 16, and dual chamber (DDD/DVI) in 23 patients. Only those patients affected by the isolated vasodepressor form were excluded. Follow-up lasted 12 ± 5 months. Symptoms were totally eliminated in 67% of patients and ameliorated with persistence of minor symptoms in 33%. All patients underwent an initial 2-month follow-up in the VVI mode. Evaluation of the 19 patients who remained symptomatic and the 20 who became asymptomatic with VVI pacing demonstrated that factors observed prior to pacemaker implant were related to failure of the VVI mode. These included symptomatic pacemaker effect (42% vs 0%), mixed carotid sinus syndrome (95% vs 65%), orthostatic hypotension (47% vs 15%), or ventriculoatrial conduction (68% vs 38%). In the 23 patients with dual chamber pacing, random 2 month comparisons were performed between VVI and DVI/DDD pacing. The dual chamber mode was preferred by 14 patients, none preferred the VVI mode and nine noted no difference. Comparison of the two groups found that the factors linked to DVI/DDD preference were symptomatic pacemaker effect (50% vs 0%), ventriculoatrial conduction (78% vs 44%), or orthostatic hypotension (50% vs 11 %). VVI pacing is efficacious in a high proportion of patients affected by cardioinhibitory or mixed carotid sinus syndrome. The identification of causes of VVI pacing failure allows determination of those who will benefit from VVI pacing and those who should have DVI/DDD. VVI pacing is suggested for the cardioinhihitory type with no symptomatic pacemaker effect and for the mixed type with no symptomatic pacemaker effect or orthostatic hypotension or ventriculoatrial conduction. Dual chamber pacing should be used in all other instances.     

二维彩色多普勒超声在主动脉窦瘤诊断中的应用

目的：探讨二维彩色多普勒超声（2D-CDFI）诊断主动脉窦瘤的价值。方法：对57例超声诊断为主动脉窦瘤患者超声资料与术后结果进行对照分析。结果：2D-CDFI正确诊断54例（94.7％）、误诊3例（5.3％）。结论：2D-CDFI对主动脉窦瘤的诊断有很高的临床价值，约95％的病例可确诊。但易有假阳性的诊断。     

彩色多普勒超声对主动脉窦瘤破裂的定位和血流动力学变化的研究

本文对２５例主动脉窦瘤破裂患者进行了彩色多普勒超声诊断与手术对照，结果表明，彩色多普勒超声能直接显示出窦瘤破裂的部位、程度，弄清窦瘤破裂的血流动力学变化，能敏感地显示出合并症，对掌握手术时机，决定手术方案起到了极为重要的作用