64层螺旋CT使用低剂量对比剂在CTA中对脑动脉瘤的诊断价值

目的 研究64层螺旋CT使用低剂量对比剂联合生理盐水在CTA中对脑动脉瘤的应用价值.方法 对临床疑有脑动脉瘤51例患者分为三组:甲组90ml对比剂不用生理盐水冲洗；乙组、丙组分别使用70ml、50ml对比剂之后用相同流速生理盐水40ml冲洗.对比剂流速为5.0ml/s.当颈内静脉显影的一刹那开始扫描.利用工作站软件进行图像处理,评估三组血管图像质量及动脉瘤显示情况.结果 三组病例动脉瘤的灵敏度、特异性在统计学上没有明显差异,甲组动静脉均显示很好,CT值较高.丙组动脉显示良好,静脉少,污染轻,血管CT值略低.乙组居于二者之间.结论 使用低剂量对比剂50ml+40ml生理盐水以5.0ml/s流率注射,不仅可以得到理想的图像,还是一种安全、快速、经济的检查方法.     

Vasculo–Behçet's syndrome with widespread arterial involvement

Abstract

An 18-year-old woman with a history of multiple oral ulcers followed by erythema nodosum was admitted to our hospital because of the lack of a pulse in her upper left extremity and occasional dizziness. High C-reactive protein (CRP) levels were detected in her serum. Arterial angiography showed a widespread narrowing of the major arteries, including both carotid arteries, the left vertebral artery, the left subclavian artery (branches of the aortic arch), the abdominal aorta, and left renal arteries. However, no involvement in the circle of Willis was noted, and this was confirmed by magnetic resonance angiography. Pulmonary scintigraphy showed no perfusion defect. The distribution of the arterial involvement, her youth, and nega-tive human leukocyte antigen (HLA) B51 were consistent with Takayasu arteritis, although the presence of mucocutaneous involvement favored a diagnosis of vasculo-Behçet's syndrome. We treated the patient with prednisolone and warfarin, which resulted in an improvement in CRP levels and no thrombosis-related complications.     

索拉菲尼治疗进展期原发性肝癌患者有效性及安全性研究*

目的 探讨应用索拉菲尼治疗进展期原发性肝癌(aPLC)患者的有效性和安全性。方法 2013年4月~2016年12月我科诊治的aPLC患者82例,采用随机数字表法分为两组,每组41例。两组均给予射频消融术（RFA）治疗,观察组患者在RFA前后接受索拉菲尼治疗,观察12 w。采用ELISA法检测血清碱性成纤维细胞生长因子（bFGF）和血管内皮生长因子（VEGF）。结果 2例观察组患者被剔除,3例对照组患者失访;在治疗12 w末,观察组疾病控制率为61.5%,与对照组的52.6%比,差异无统计学意义（P>0.05）,但观察组肿瘤客观有效率为48.7%,显著高于对照组的26.3%,差异有统计学意义（P<0.05）;观察组血清AFP、bFGF和VEGF水平分别为（184.7±10.5）μg/L、（3.8±1.3） pg/mL和（172.3±25.4） pg/mL,均显著低于对照组的（213.6±11.6） μg/L、（6.4±2.0） pg/mL和（210.5±28.3） pg/mL,差异有统计学意义（P<0.05）;观察组中位无进展生存期（PFS）为10.2个月（95%CI为7.4~11.5）,对照组为7.9个月（95%CI为 6.0~10.1）,经Log-rank检验显示两组差异有统计学意义（P<0.05）;观察组在服药过程中手足综合征、皮疹、白细胞减少、口腔黏膜炎、脱发和肝功能异常发生率分别为43.6%、25.6%、17.9%、20.5%、25.6%和23.1%,显著高于对照组的0.0%、2.6%、0.0%、0.0%、0.0%和5.3%,差异有统计学意义（P<0.05）。结论 索拉菲尼可控制aPLC患者实体瘤扩散,延长无进展生存期,但索拉菲尼可引起多种不良反应,在用药过程中应注意观察并及时采取相应处理措施,以防止发生严重不良反应。     

Demonstration of Traumatic Subarachnoid Hemorrhage from the Anterior Choroidal Artery

We present a case of angiographically confirmed transection of the cisternal segment of the anterior choroidal artery (AChA) associated with a severe head trauma in a 15-year old boy. The initial brain computed tomography scan revealed a diffuse subarachnoid hemorrhage (SAH) and pneumocephalus with multiple skull fractures. Subsequent cerebral angiography clearly demonstrated a complete transection of the AChA at its origin with a massive extravasation of contrast medium as a jet trajectory creating a plume. We speculate that severe blunt traumatic force stretched and tore the left AChA between the internal carotid artery and the optic tract. In a simulation of the patient''s brain using a fresh-frozen male cadaver, the AChA is shown to be vulnerable to stretching injury as the ipsilateral optic tract is retracted. We conclude that the arterial injury like an AChA rupture should be considered in the differential diagnosis of severe traumatic SAH.     

Advances in Percutaneous Coronary Interventions for Elderly Patients

Coronary heart disease (CHD) is one of the leading causes of morbidity and the most common cause of death in older adults. Paradoxically, elderly patients tend to be systematically excluded from randomized-controlled cardiovascular trials, which complicates decision-making in this population. Management of CHD in the elderly is frequently more difficult in virtue of chronic comorbid conditions and aging-intrinsic dynamics. Despite these challenges, the number of elderly and very elderly patients undergoing percutaneous coronary interventions (PCI) is increasing. Elderly patients in many registries and large clinical series exhibit even a greater benefit from interventional procedures than younger patients, but they have a higher rate of overall complications. We present an overview of the current available evidence of PCI in older adults with stable and unstable CHD, including comparisons between drug-eluting and bare-metal stents, transfemoral and transradial access, and methods of revascularization. Adjuvant antiplatelet and antithrombotic therapies are also discussed.     

Intraoperative ICG fluorescence contrast imaging of the main artery watershed area in colorectal cancer surgery: Report of a case

IntroductionVisualization of the main artery watershed area may be useful for determining the area that should be resected in colorectal cancer surgery. Resection of the main artery watershed area may result in complete resection of lymph nodes along the main artery and area of potential ischemia.Presentation of caseA man in his 60 s with a chief complaint of hematochezia visited our hospital, was diagnosed with colorectal cancer and underwent surgery. A case that underwent colorectal resection with intraoperative indocyanine green (ICG) fluorescence angiography from the resection-side of the superior rectal artery (SRA) in order to confirm the watershed area is reported. Observation was performed using a PINPOINT^® bright-field, color, near-infrared fluorescence camera, and the watershed area of the SRA fluoresced 33 s after the intra-arterial injection of ICG. After observation resection and anastomosis was performed. The patient’s postoperative course was good.DiscussionThe method is simple and can be performed within a short time, and it enables visual evaluation of the blood flow in the intestinal tract before anastomosis.ConclusionThis method can be expected to provide useful information for complete resection of lymph nodes along the main artery and area of potential ischemia.     

CREANUIS: A Non-linear Radiofrequency Ultrasound Image Simulator

Nonlinear ultrasound methods are widely used in clinical applications for tissue or contrast harmonic imaging. Accurate non-linear imaging simulation tools are required in research studies for the development of new methods. However, in existing simulators, the possible inhomogeneity of the coefficient of non-linearity, which is generally observed in tissue and in particular when contrast agents are involved, has not yet been implemented. This article describes a new ultrasound simulator, called CREANUIS, devoted to the computation of B-mode images where both linear and non-linear propagation in media is considered, with a possible inhomogeneous coefficient of non-linearity. The resulting fundamental images, based on a spatially variant and non-linear point spread function, are in accordance with those obtained through the reference linear FieldII simulator, with computation time reduced by a factor of at least 1.8. Non-linear images of media exhibiting inhomogeneous coefficients of non-linearity are also provided. The simulation software can be freely downloaded from our website.     

Early heparinization decreases the incidence of left atrial thrombi detected by intracardiac echocardiography during radiofrequency ablation for atrial fibrillation

INTRODUCTION: We reviewed our experience in managing intracardiac ultrasound-detected left atrial thrombus and analyzed the impact of the timing of heparin therapy on thrombus incidence. METHODS AND RESULTS: We identified 508 patients undergoing ablation procedures for atrial fibrillation in which intracardiac ultrasound was used. All patients received unfractionated heparin during the procedure: 31 patients before the first transseptal puncture (preTS1), 257 between the first and second transseptal punctures (TS1-TS2), and 220 following both punctures (postTS2). By using intracardiac echocardiography (ICE), thrombus was detected in 30 of these 508 patients (5.9%). Of these, 29 were in the left atrium and constituted our study group. In 21 patients, the thrombi were successfully aspirated from the left atrium using strong suction through the transseptal sheath. All patients in whom thrombi were aspirated did well without neurological event or death. When patients received heparin therapy either preTS1 or TS1-TS2, there was a significant decrease in the occurrence of ICE-detected left atrial thrombus compared with those who received heparin postTS2 (0 of 31 patients (0%) preTS, 9 of 257 (3.5%) TS1-TS2, and 20 of 220 (9.1%) postTS2; (preTS1 vs postTS2, p = 0.01; preTS2 [preTS1 and TS1-TS2] vs postTS2, p < 0.001). CONCLUSION: Early administration of intravenous heparin, specifically before transseptal puncture, decreases the incidence of left atrial thrombi.     

彩色多普勒血流成像和数字减影血管造影评估糖尿病外周血管病变的符合率

目的探讨彩色多普勒血流成像（CDFI）和数字减影血管造影（DSA）用于评估糖尿病外周血管病变（PVD）的符合率，为临床选择适当的检查方法提供依据。方法22例2型糖尿病患者同时进行下肢胫前动脉（ATA）和胫后动脉（瞰）的CDFI和DSA。以血管最狭窄部位的收缩期最大血流速度）（Vs）与同一血管正常、Vs平均值的比值作为CDFI判断下肢动脉狭窄程度的指标。以DSA作为金标准，计算CDFI诊断PVD的最大符合率、敏感性、特异性、阳性预测值和阴性预测值。结果与DSA比较，CDFI评估糖尿病PVD的敏感性为84％，特异性为83％，阳性预测值（＋PV）为68％，阴性预测值（-PV）为92％，符合率84％。结论与DSA比较，CDFI诊断糖尿病PVD有较好的符合率，在大部分情况下可以代替DSA评估糖尿病PVD。