Preoperative sonographic radial artery evaluation and correlation with subsequent radiocephalic fistula outcome.

OBJECTIVE: Primary failure of forearm radiocephalic dialysis fistulas is common even when preoperative vascular mapping is used. Previous studies have suggested that low peak systolic velocity of the radial artery predicts subsequent fistula failure. The study goal was to evaluate whether preoperative spectral Doppler assessment of radial artery inflow can improve forearm fistula outcome prediction. METHODS: Forearm fistulas were placed in 112 patients after preoperative sonographic mapping. Preoperative spectral Doppler sonography measured radial artery peak systolic velocity during tight fist clenching for 3 minutes and after fist relaxation. Vessel diameters and peak systolic velocity were assessed for predictive value based on subsequent fistula adequacy. Fistula flow rates were determined 6 to 12 weeks postoperatively in a subset of patients. RESULTS: Failed and successful fistulas were similar in their preoperative arterial and vein diameters, resistive index, and peak systolic velocity during fist clenching and after fist relaxation. Specifically, there was no difference in fistula success with radial artery peak systolic velocity lower than 50 cm/s versus peak systolic velocity of 50 cm/s or higher. The change in peak systolic velocity after fist relaxation was highly predictive of subsequent fistula outcome among female patients in ad hoc analysis. Fistula adequacy for dialysis in women was 11% when the change in peak systolic velocity was lower than 0 cm/s and 50% when the change was 0 cm/sec or higher (P = .02). The postoperative fistula flow rates were lower when the preoperative change in peak systolic velocity was lower than 0 cm/s than when it was 0 cm/s or higher (316 +/- 46 versus 781 +/- 150 mL/min; P = .003). CONCLUSIONS: There was no difference in the preoperative peak systolic velocity or the resistive index of successful and failed fistulas. Measurement of the radial artery peak systolic velocity change after release of fist clenching was not useful in predicting outcomes in male patients but identified a subset of female patients with a very low likelihood of success. This criterion may merit further investigation in future trials.     

内支架治疗消化道恶性梗阻的探讨

目的探讨内支架治疗消化道恶性梗阻和食管-支气管瘘的有效性和安全性。方法71例消化道恶性梗阻和食管-支气管瘘患者采用永久性部分覆膜镍钛合金内支架治疗,全部病例均在DSA监视下经口或肛门将支架置放于梗阻或瘘口部位,术前术后均做造影对照,根据进食进水和排便情况评价疗效。结果上消化道支架置入后恢复饮食,饮水后无呛咳62例(96.9%);乙状结肠和直肠支架置入后肠梗阻症状均即刻解除;术后支架移位2例(2.8%);再狭窄2例(2.8%);声音嘶哑1例(1.4%);胸部剧烈疼痛2例(2.8%),轻度疼痛12例(16.9%);大出血1例(1.4%),经相应处理后全部好转。结论永久性部分覆膜镍钛合金内支架置入术是消化道恶性梗阻和食管-支气管瘘的有效治疗方法,操作简便,安全性高。     

食道贲门癌100例治疗体会

本文报告1976～1986年收治的食道贲门癌100例的治疗体会。其中男性95例,女性5例,年龄20～79岁,平均52岁。上段食管癌5例,中段59例,下段24例,贲门癌12例。84例作食管、贲门癌切除,食管胃吻合术,切除率为84％;13例因病变不能切除而作食管胃转流术,3例仅作剖胸探查。本组死亡1例,死亡率为1％,好转13例(13％),治愈84例,治愈率为84％。重点讨论了食胃吻合口瘘管和狭窄,以及肺部并发症的预防。     

彩色多普勒超声心动图在冠状动脉瘘封堵术中的价值

目的探讨彩色多普勒超声心动图（CDE）在冠状动脉瘘（CAF）封堵术中的价值。 方法应用CDE选择10例CAF实施封堵，封堵术后应用CDE判定疗效。 结果根据CDE选择10例CAF，9例成功实施封堵。其中8例首次封堵术后CDE复查瘘口处分流束血流信号消失，1例首次封堵术后CDE复查瘘口处显示少量残余分流束血流信号，再次封堵术后CDE复查瘘口处分流束血流信号消失。另外1例因瘘口直径过大封堵失败又行开胸手术治疗。 结论CDE在CAF封堵术中具有重要临床价值。封堵术前CDE明确指出哪一支冠状动脉瘘至哪个心腔、瘘口直径及除外合并畸形是成功实施封堵的关键；封堵术后CDE判断疗效重点观察封堵器位置及瘘口处是否有残余分流束血流信号。     

多层螺旋CT动态增强扫描对肝细胞癌合并肝动脉-门静脉瘘的诊断价值

目的探究多层螺旋CT动态增强扫描对肝细胞癌合并肝动脉-门静脉瘘的诊断价值。方法选择2018年10月至2019年10月本院收治的50例肝细胞癌患者作为研究对象。所有患者均接受多层螺旋CT动态增强扫描和数字化血管造影诊断。将数字化血管造影结果视为金标准,分析多层螺旋CT动态增强扫描结果。结果数字化血管造影检出19例肝动脉-门静脉瘘,多层螺旋CT动态增强扫描检出16例肝动脉-门静脉瘘(中央型9例、周围型7例)。多层螺旋CT动态增强扫描检测肝细胞癌患者肝动脉-门静脉瘘的灵敏度为84.21%,特异度为41.94%,漏诊率为15.79%,误诊率为58.06%。结论多层螺旋CT动态增强扫描在肝细胞癌合并肝动脉-门静脉瘘患者诊断中能够取得较为理想的效果,值得推荐。     

寰枕交界区硬脊膜动静脉瘘的诊断与治疗(2例报告并文献复习)

目的探讨寰枕交界区硬脊膜动静脉瘘诊断与治疗。方法采用多模式影像学方法诊断,枕下后正中入路手术治疗寰枕交界区硬脊膜动静脉瘘患者2例,并结合文献进行分析。结果本组2例寰枕交界区硬脊膜动静脉瘘患者均表现为自发性蛛网膜下腔出血,均经DSA确诊,并经枕下后正中入路成功阻断瘘口后引流静脉。结论寰枕交界区硬脊膜动静脉瘘发病率低,缺乏特征性临床表现,诊断困难;多模态影像、尤其是DSA是确诊的主要方法;开颅手术切断瘘口后引流静脉是相对安全、有较高病灶闭塞率的治疗方法。     

Subclavian Steal Syndrome with or without Arterial Stenosis: A Review

The subclavian‐vertebral artery steal syndrome (SSS) is the hemodynamic phenomenon of blood flow reversal in the vertebral artery due to significant stenosis or occlusion of the proximal subclavian artery or the innominate artery. Occasionally, SSS is diagnosed in patients not harboring arterial stenosis. With the exception of arterial congenital malformations, the limited case reports of SSS with intact subclavian artery are attributed to dialysis arteriovenous fistulas (AVFs). Interestingly, these cases are more frequently symptomatic than those with the classical atherosclerotic SSS forms. On the other hand, the disclosure of SSS due to subclavian/innominate artery atherosclerotic stenosis, even in the absence of accompanying symptoms, should prompt a thorough cardiovascular work‐up for the early detection of coexisting coronary, carotid, or peripheral artery disease. Herein, we review the incidence, clinical presentation, sonographic findings, and therapeutic interventions related to SSS with and without subclavian/innominate artery stenosis. We also review the currently available data in the literature regarding the association of SSS and dialysis AVF. In addition, we present a patient with bilateral symptomatic SSS as the result of an arteriovenous graft (AVG) that was introduced after the preexisting AVF in the contralateral arm became nonfunctional. SSS due to subclavian or innominate artery stenosis/occlusion is rarely symptomatic warranting interventional treatment. In contrast, when it is attributed to AVF, surgical correction is frequently necessary.     

冠状动脉瘘──国内报道67例的临床分析

目的：冠状动脉瘘虽属少见疾病，但临床上易和其他先天性心脏病混淆而造成误诊。本研究旨在提高对该病的认识以减少误诊率。方法：作者报告３例冠状动脉瘘并综合国内文献共６７例，皆经心血管造影或手术确诊。对其病理解剖、临床表现、实验室检查和手术结果进行统计分析。结果：本组冠状动脉篓起源于左、右和双侧冠状动脉者分别为１７、４９和１例。临床上无特征性症状，瘘口在右心系统者多有连续性杂音（３０／３２），而在左心室者无一例连续性杂音（０／６）。本组手术治疗５７例，手术晚期死亡１例，４２例随访３个月至２５年，其中１例症状恶化，４１例症状改善。结论：本病血液动力学改变与瘘口大小及部位有关，改变明显者出现心肌缺血和心脏扩大，升主动脉造影和选择性冠状动脉造影有重要诊断价值。对有明显临床及血液动力学异常者应行手术治疗。     

Determinants of postoperative morbidity and mortality in children managed for typhoid intestinal perforation in Kano Nigeria

Background

Intestinal perforation is a serious but poorly understood complication of typhoid fever. This study aims to determine the patient factors associated with postoperative morbidity and mortality.