Cerebral Angiographic Findings of Cosmetic Facial Filler-related Ophthalmic and Retinal Artery Occlusion

Cosmetic facial filler-related ophthalmic artery occlusion is rare but is a devastating complication, while the exact pathophysiology is still elusive. Cerebral angiography provides more detailed information on blood flow of ophthalmic artery as well as surrounding orbital area which cannot be covered by fundus fluorescein angiography. This study aimed to evaluate cerebral angiographic features of cosmetic facial filler-related ophthalmic artery occlusion patients. We retrospectively reviewed cerebral angiography of 7 patients (4 hyaluronic acid [HA] and 3 autologous fat-injected cases) showing ophthalmic artery and its branches occlusion after cosmetic facial filler injections, and underwent intra-arterial thrombolysis. On selective ophthalmic artery angiograms, all fat-injected patients showed a large filling defect on the proximal ophthalmic artery, whereas the HA-injected patients showed occlusion of the distal branches of the ophthalmic artery. Three HA-injected patients revealed diminished distal runoff of the internal maxillary and facial arteries, which clinically corresponded with skin necrosis. However, all fat-injected patients and one HA-injected patient who were immediately treated with subcutaneous hyaluronidase injection showed preserved distal runoff of the internal maxillary and facial arteries and mild skin problems. The size difference between injected materials seems to be associated with different angiographic findings. Autologous fat is more prone to obstruct proximal part of ophthalmic artery, whereas HA obstructs distal branches. In addition, hydrophilic and volume-expansion property of HA might exacerbate blood flow on injected area, which is also related to skin necrosis. Intra-arterial thrombolysis has a limited role in reconstituting blood flow or regaining vision in cosmetic facial filler-associated ophthalmic artery occlusions.     

Catheter ablation of the atrioventricular node using radiofrequency energy

Background: Catheter ablation of the atrioventricular (AV) junction using stored direct current (DC) energy from a standard DC Cardioverter defibrillator was first reported in 1982. Since then many patients have been treated using this procedure for refractory supraventricular arrhythmias, usually atrial fibrillation and flutter. Undesirable thermal effects such as barotrauma and arcing are largely responsible for complications associated with the use of DC energy. This report details our experience of catheter ablation of the AV junction using radiofrequency (RF) energy in a series of 30 consecutive patients. Methods: RF ablations were performed using steerable Mansfield (Webster Laboratories) 4 mm tipped electrodes and locally assembled RF energy delivery system. Results: The procedure was successful in 27/30 (90%) patients using RF energy, while three patients required DC energy to achieve successful AV junction ablation. General anaesthesia was required in nine patients, six of whom required this for cardioversion to sinus rhythm so that an adequate His Bundle spike could be recorded and three for DC ablation. Dual chamber permanent pacemakers with automatic mode switching were implanted in four patients who had paroxysmal atrial fibrillation or flutter and the remainder had ventricular rate responsive pacemakers. Conclusions: In patients with drug refractory paroxysmal atrial fibrillation and flutter and in patients with established atrial fibrillation where control of the ventricular rate is difficult, catheter ablation of the AV junction using RF energy is a safe and effective procedure with a high success rate.     

Mechanism of recurrence after radiofrequency catheter ablation of atrial fibrillation guided by complex fractionated atrial electrograms

Background A better understanding of the mechanisms of recurrent atrial fibrillation (AF) after radiofrequency ablation of complex, fractionated atrial electrograms (CFAEs) may be helpful for refining AF ablation strategies. Methods and results Electrogram-guided ablation (EGA) was repeated in 30 consecutive patients (mean age = 59 ± 8 years) for recurrent paroxysmal AF, 10 ± 4 months after the first ablation. During the first procedure, CFAEs were targeted without isolating all pulmonary veins (PVs). During repeat ablation, all PVs and the superior vena cava (SVC) were mapped with a circular catheter and the left atrium was mapped for CFAEs. EGA was performed until AF was rendered noninducible or all identified CFAEs were eliminated. During repeat ablation, ≥1 PV tachycardia was found in 83 PVs in 29 of the 30 patients (97%). Among these 83 PVs, 63 (76%) had not been completely isolated previously. During repeat ablation, drivers originating in a PV or PV antrum were identified only after infusion of isoproterenol (20 μg/min) in 12 patients (40%). At 9 ± 4 months of follow-up after the repeat ablation procedure, 21 of the 30 patients (70%) were free from recurrent AF and flutter without antiarrhythmic drugs. Conclusions Recurrence of AF after EGA is usually due to PV tachycardias. Therefore, it may be preferable to systematically map and isolate all PVs during the first procedure. High-dose isoproterenol may be helpful to identify AF drivers.     

55例大型脑膜瘤术前栓塞的应用评价

目的：研究大型脑膜瘤的术前栓塞的的应用价值。方法选择55例大型脑膜瘤患者（最大径＞5 cm）,分成栓塞组(n=28)和对照组(n=27),栓塞组术前先予以DSA（digital subtraction angiography）造影了解肿瘤血供情况,并予以PAV颗粒或栓塞微球颗粒（200～300 um）栓塞,对照组未予以栓塞,对比2组肿瘤切除出血量、手术时间,观察手术并发症情况;术后1～2周复查增强MR观察肿块切除程度。结果研究组术中出血量（456±145）mL,明显小于对照组（913±134）mL,差异有统计学意义（P<0.05）。手术时间,研究组与对照组分别为（4.45±2.13）h和（5.23±1.45）h,差异有统计学意义（P<0.05）。栓塞组提高了肿瘤的切除率,4例出现栓塞后颅内高压,头痛加重,1例出现颅神经一过性麻痹,3例出现局部头皮坏死,经支持治疗后均缓解。结论大型脑膜瘤术前血管造影可以了解肿瘤血管情况,指导外科手术切除,栓塞术后可以明显减少术中出血,缩短手术时间,提高肿瘤切除程度。     

食管射频消融术后发热的影响因素分析

目的　探讨食管内镜下射频消融术（radiofrequency ablation,RFA）后患者发热的独立危险因素。方法　2016年1月—2021年4月,因早期食管癌就诊于长海医院消化内科,且病变范围超过食管3/4环周的51例病例纳入病例对照研究。患者均行RFA治疗,按术后是否发热分成发热组（n=15）和未发热组（n=36）,主要收集患者一般情况、消化道肿瘤家族史、病变长度、病变范围、消融能量和消融次数用于单因素分析,其中P<0.1的变量再进一步纳入多因素Logistic回归分析探究RFA术后发热的独立危险因素。结果　单因素分析发现,病变长度（t=-3.89,P<0.001）、病变范围（χ2=11.52,P=0.001）和消融能量（P=0.001）在2组间差异有统计学意义。Pearson相关性显示,病变长度与病变环周长度存在明显正相关（r=0.71,P<0.001）,而病变范围由病变环周长度决定,因此最终将病变长度和消融能量这两个变量纳入Logistic回归方程。Logistic回归分析结果显示,食管病变长度每增加1 cm,患者发生RFA术后发热的风险是前者的1.21倍（95%CI：1.01～1.43,P=0.037）;术中使用12 J消融能量者,发生RFA术后发热的风险是使用10 J消融能量者的0.43倍（95%CI：0.22～0.85,P=0.015）。结论　病变长度和消融能量是导致食管RFA术后发热的独立危险因素。长节段早期食管癌者更易发生RFA术后发热,术中使用低消融能量者更易发生RFA术后发热。     

16层螺旋CT血管成像对蛛网膜下腔出血病因的诊断价值

目的：探讨分析16层螺旋CT血管成像对蛛网膜下腔出血(SAH)病因的诊断价值。方法58例蛛网膜下腔出血患者,均先行16层螺旋CT平扫,再行CT血管成像(CTA),之后应用多平面重建、容积再现、最大密度投影等技术,对图像进行处理,观察患者的脑血管情况并对SAH病因进行分析。结果经3D-CTA共发现46例患者有56个动脉瘤、动静脉畸形8例、烟雾病3例、阴性1例;与数字减影血管造影(DSA)或外科手术作为参照,提示3D-CTA诊断颅内动脉瘤的敏感性与特异性分别为97.83%与100.00%。结论16层螺旋CT血管成像在蛛网膜下腔出血的病因诊断中具有较高应用价值,可作为诊断蛛网膜下腔出血病因的首选方法。     

Computed Tomography Angiography with Three‐dimensional Reconstruction for Pulmony Venous Definition in High‐risk Infants with Congenital Heart Disease

Background. Pulmonary venous anomalies may be difficult to define in small, critically ill infants using standard echocardiography. In many centers, invasive cardiac catheterization is used if the diagnosis remains inconclusive. We evaluated computed tomography angiography (CTA) as a low‐risk alternative to cardiac catheterization in these infants. Methods. All infants <7 kg with congenital heart disease who had undergone CTA in a tertiary care pediatric institution during a 30‐month period were included. All had undergone preceding echocardiography, with pulmonary veins defined as normal (group A, n = 40), or abnormal (group B, n = 16). In 6 group B patients, a conclusive diagnosis could not be made by echocardiogram alone. CTAs were analyzed only if contrast density in the left atrium exceeded 200 Houndsfield units. CTA diagnoses (using axial and reformatted 3‐dimensional still frame images, and audio video interleaved loops) were compared with preceding echocardiograms (group A), or echocardiography, catheterization angiography, or surgical findings (group B). Results. Fifty‐six patients (mean age 12.4 weeks; range 0–64; mean weight 4.19 kg; range 1.4–7) were included. There were no scan complications. Mean scan duration was 4.6 seconds (range 1.84–11). Scan indications in group A were related mainly to arch (57.5%) and airway issues (17.5%). In group B, most patients had variations of anomalous pulmonary venous return (43.75%), with postsurgical stenosis the second largest group (31.25%). CTA diagnoses were confirmed in all patients. Additional diagnostic confirmation in group B was made at catheterization (1/16) or during surgical intervention (15/16). Conclusion. Normal and abnormal pulmonary veins could be defined accurately, safely, and rapidly by CTA in all cases. Three‐dimensional reformatting provided additional assistance with surgical planning. Echocardiography remains the first‐line choice for diagnostic imaging in all patients with pulmonary venous anomalies. However, when echo diagnosis is inconclusive, CTA and not catheterization should be considered the next imaging modality of choice.     

不完全射频消融对兔VX2肝癌MMP-9表达的影响

目的研究不完全射频消融（RFA）治疗对兔VX2肝癌模MMP-9蛋白表达的影响。 方法建立新西兰白兔的VX2肝癌模型,将30只兔VX2肝癌模型分为2组,即对照组和实验组,每组15只,对照组只做开关腹,而不进行RFA;实验组进行开腹消融,消融范围为肿瘤组织的75%;在实验组中设立RFA后快速进展亚组,定义为实验结束时肿瘤的倍增率大于对照组。对比其RFA后的VX2肝癌的体积变化、残留VX2肝癌基质金属蛋白酶-9（MMP-9）的表达情况。 结果对照组和实验组治疗后肿瘤体积分别为（7 862±1 304）mm³和（6 996±709）mm³,肿瘤的倍增率分别为（291±49）和（232±16）,差异有统计学意义（P < 0.05）。对照组和实验组MMP-9阳性表达率为52.1%和46.3%,差异均有统计学意义（P < 0.05）;实验组中3只实验兔肿瘤倍增率及MMP-9表达率明显高于实验组,属于RF后快速进展亚组,差异有统计学意义（P < 0.05）。 结论部分性消融对大多数肝细胞癌具有一定疗效,但对于少数肿瘤可能加速其生长,而MMP-9的过表达可能是促进残留癌快速进展的原因。     

射频消融治疗心动过速远期疗效分析

1995年前射频消融（RFCA）治疗各类心动过速120例，总成功率97.5％。采用心电图、动态心电图或经食管心房调搏检查保持随访的共108例，随访时间6～35个月，复发3例，心动过速复发率2．8％。复发的3例经分析与消融放电时间太短、未能造成稳定性损伤有关。59例术后1～3个月二维超声心动图复查未发现因RFCA而造成心脏结构、舒缩功能和射血分数等改变。     

经主动脉窦途径射频消融心动过速临床研究

目的:探讨经主动脉窦途径导管射频消融治愈的快速性心律失常患者的心电图特点及射频消融情况.方法:回顾性分析17例室性心动过速/室性期前收缩、前间隔房性心动过速及前间隔旁路等该类患者的体表心电图、及消融成功时靶点电图等心电生理学特征.结果:经主动脉窦途径导管射频消融治愈室性心动过速/室性期前收缩12例,其中起源于左冠状动脉窦(左冠窦)10例、右冠状动脉窦(右冠窦)2例;源于无冠状动脉窦(无冠窦)的局灶性前间隔房性心动过速3例及前间隔旁路2例.室性心动过速/室性期前收缩心电图特点:Ⅱ、Ⅲ和aVF导联为高大R波,胸导联R波移行较早,V1导联r/S波振幅比≥30%,r波时限(82.2±16.4)ms,V1导联中r/QRS波时限比≥50%,V5、V6导联为高振幅R波、无s波.有效消融靶点心内电图示心室波明显比体表心电图QRS波提前(35.2±21.6)ms.前间隔房性心动过速均能被心房刺激反复诱发和终止,其心电图特点:房性心动过速时P波间期明显窄于窦律时P波间期,Ⅰ、aVL导联P波正向,Ⅱ、Ⅲ和aVF导联P呈负正双向.在心房标测中提示最早的心房激动在希氏(His)束区,但在主动脉无冠窦内标测的心房激动较His束区的心房波提前,其解剖定位于His束上后方,消融靶点无His束电位.前间隔旁路心电图示:窦性心律时呈窄QRS波形,未见预激波,心动过速呈窄QRS形,在无冠窦内记录到最早心房激动点,且无His束电位.17例均消融成功.结论:源于主动脉窦内的室性心动过速/室性期前收缩、前间隔房性心动过速和前间隔旁路具有相对的心内电生理学特征,常规心内膜途径消融困难时应该考虑从主动脉窦途径标测消融策略,把握消融导管与冠状动脉的关系,导管消融治疗安全而有效.