化瘀通脉颗粒干预经皮腔内冠状动脉介入治疗术后再狭窄的临床研究

目的观察化瘀通脉颗粒干预冠心病经皮腔内冠状动脉介入治疗(PCI)术后再狭窄的临床效果。方法将60例冠心病经PCI治疗患者随机分为对照组和治疗组,治疗组31例,对照组29例。对照组按照常规治疗方法治疗,治疗组在对照组药物基础上加服化瘀通脉颗粒治疗。两组疗程均为6个月。结果治疗组总有效率为83.87%,明显高于对照组的62.07%(P0.05)。治疗组中医症状积分降低较对照组更加明显(P0.05)。治疗组心绞痛和临床再狭窄人数明显少于对照组(P0.05);冠脉CTA再狭窄发生人数治疗组也少于对照组(P0.05)。结论化瘀通脉颗粒具有预防PCI术后再狭窄的作用。     

CT三维重建联合肾脏血管造影在经皮肾镜取石术治疗鹿角形肾结石中的应用研究

目的探讨螺旋CT三维重建联合肾脏血管造影(CTA)在经皮肾镜取石术(PCNL)治疗鹿角形肾结石的可行性及临床效果。方法本组34例鹿角形肾结石均行经皮肾镜取石术,观察手术时间、术中失血量、结石清除率。结果全部手术均取得成功,无严重并发症发生。手术耗时1.0～2.5h,平均1.5h。出血量30～300ml,平均112±30ml。总结石清除率91.4%。结论 CT三维重建联合肾脏CTA可提供肾盂肾盏集合系统、肾实质血管分布的清晰图像,并可发现结石和明确结石与肾盂肾盏集合系统的关系,可在术前发现肾动静脉瘘。与静脉尿路造影相比较,三维CT重建更有利于确定经皮肾穿刺的部位及穿刺通道选择。对于鹿角形肾结石,CT三维重建联合肾脏CTA应该成为经皮肾镜取石术前一种常规的影像学定位方法。     

寰椎椎弓根钉内固定通道的三维CT影像学研究

目的利用三维影像学探讨常人寰椎椎弓根钉内固定通道的解剖学基础。方法从本院PACS系统中随机选取60例头颈部CTA枕寰枢复合体无明确异常的影像学资料,进行回顾性三维CT成像。测量相关解剖学数据,以颈椎扩孔器横截面面积(3~5 mm2)为对照,归纳出3种椎弓根类型。结果 60例头颈部CTA三维图像显示寰椎及周围结构清楚,测量出寰椎椎动脉沟底部后弓外径高度男性(4.39±1.16)mm,女性(3.84±0.84)mm,小于常规螺钉直径(3.50 mm)占27.7%;在寰椎椎弓根通道分型中,Ⅰ型68侧,占56.67%,Ⅱ型25侧,占20.83%;Ⅲ型27侧,占22.50%;皮质骨面积比例随通道面积的减小而增大,在各型椎弓根通道都在80%以上。结论寰椎椎动脉沟底部后弓外径高度是制约寰椎椎弓根钉固定的重要因素,而寰椎椎弓根骨性通道的解剖结构特点则影响置钉技术的选择;设计出适应寰椎椎动脉沟底部后弓外径高度的螺钉是非常必要的。     

双源CT前瞻性心电触发技术用于脑血管成像的初步研究

目的 探讨双源Flash Spiral CT前瞻性心电触发序列(step-and-shoot,SAS)模式脑血管成像的图像质量及辐射剂量.方法 将43例临床怀疑脑血管性病变的患者,行前瞻性心电触发序列模式的脑血管造影术( SAS-CTA)扫描,采集期相:应用60％ R-R间期的ECG演示模式,对SAS-CTA做图像后处理,分析评价图像质量评分、统计辐射剂量及优良率.结果 评价SAS-CTA,图像质量评分为4.72±0.50,优良率达97.7％ (42/43),平均有效剂量为(0.216±0.01) mSv,SAS-CTA有效辐射剂量与双能量CTA( DE-CTA)比较降幅达到76.31％.结论 前瞻性心电触发序列模式应用于脑血管成像,可在保证图像质量的同时显著降低辐射剂量.     

Endovascular repair of acute traumatic injury of thoracic aorta

Blunt thoracic aortic injury is associated with a high mortality rate. It is the second leading cause of death after head injury from vehicle accidents. Surgical repair with graft interposition was the traditional treatment of blunt aortic injury however; the introduction of endovascular stent graft has revolutionized the definitive treatment of these injuries.     

Effects of Statins on Coronary Atherosclerotic Plaques: The PARADIGM Study

Objectives

This study sought to describe the impact of statins on individual coronary atherosclerotic plaques.

Panvascular disease – Diagnosis and management

Panvascular disease (PVD) increases significantly the risk for cardiovascular events (myocardial infarction, stroke and cardiovascular death); the more sites affected, the greater the risk of a major cardiac event. Despite its high incidence and severe cardiovascular prognosis, PVD has still not been well studied. History of risk factors and co-morbidities, as well as a detailed physical examination, are mandatory in the initial screening and diagnostic work-up. The ankle-brachial index and various non-invasive imaging methods such as duplex ultrasound, computed tomography or magnetic resonance angiography are used for the diagnosis of atherosclerosis in various vascular beds, while digital subtraction angiography is currently used almost exclusively in association with endovascular procedures. Appropriate utilization of techniques is based on international guidelines and a multidisciplinary discussion for each case.Management of a patient diagnosed with PVD can be very complex. Secondary preventive measures and aggressive medical treatment are needed to reduce excess cardiovascular risk. Whether routine screening for atherosclerosis at various sites in the arterial tree in all or selected patients may alter treatment to improve outcome in these patients has not been shown.In the lack of hard evidence, individualized decision-making is needed with the collaboration of many specialties in a multidisciplinary approach. In general, the more symptomatic lesion or the lesion with the strongest prognostic impact should be treated first. In selected cases combined interventions can be done. Perioperative cardiovascular complications are common in patients with PVD, thus preoperative targeted screening may be needed.Clinical studies are needed to identify more effective approaches to diagnose and treat these patients. A single trial performed so far failed to demonstrate a panvascular screening in patients with severe coronary artery disease. Meanwhile, a multidisciplinary team is often needed to optimize short- and long-term prognosis.     

MRA和CTA应用于颅内动脉瘤诊断中的比较

目的 通过与CTA的对比研究，初步探讨MRA对颅内动脉瘤的显示能力和诊断价值。方法 对14例临床怀疑颅内动脉瘤患者进行MRA和CTA检查，后处理使用最大密度投影（MIP）和容积重建（VR）。以DSA和动脉瘤夹闭术作为参考标准，比较MRA和CTA对颅内动脉瘤的显示情况。结果 在14例中，经选择性DSA和动脉瘤夹闭术证实21个动脉瘤，其中17个动脉瘤CTA和MRA均显示良好，两种检查方法所得瘤颈宽度、瘤体最长径数值比较无显著性差异（P〉0．05）。MRA发现的颅内动脉瘤敏感性为90.5％。CTA为95．2％。结论 MRA具有无创、费用低、无并发症、无放射性损害、空间分辨率高、不用造影剂即可明确诊断的优点，在评估动脉瘤及帮助确定治疗方案等方面能满足临床的需求，可以成为临床筛查大部分颅内动脉瘤的首选方法。     

Colchicine Therapy and Plaque Stabilization in Patients With Acute Coronary Syndrome: A CT Coronary Angiography Study

Objectives

The authors sought to evaluate the plaque-modifying effects of low-dose colchicine therapy plus optimal medical therapy (OMT) in patients post-acute coronary syndrome (ACS), as assessed by coronary computed tomography angiography (coronary CTA).

经颅超声造影在缺血性脑血管病诊断中的应用研究

目的：探讨经颅超声造影（CE-TCCS）在诊断缺血性脑血管病（ischemic cerebrovascular disease ,ICVD）中的应用价值。方法对81例ICVD患者颅内血管行常规超声及CE-TCCS检查。观察超声造影前后颅内动脉显示情况,并记录造影前后大脑前动脉（ aurterior cerebral artery ,ACA）、大脑中动脉（ middle cerebral artery ,MCA）双椎动脉（vertebral artery,VA）和基底动脉（basilar artery,BA）血流频谱参数,将造影前后各大血管显示情况和血流参数分别进行对比分析;将超声检查结果与计算机断层血管造影成像（ CTA ）对照。结果 CE -TCCS 明显提高MCA、ACA、VA及BV显示率（P＜0．05）,VA及BV造影后收缩期峰值速度（peak systolic velocity,Vp）、舒张末期流速（diastolic velocity,Vd）、平均流速（the average velocity,Vm）、达峰时间（time,T）均明显高于造影前（P＜0．05）,常规超声诊断ICVD颅内动脉血管狭窄或闭塞的准确性明显低于CTA（P＜0．05）。 CE-TCCS诊断ICVD颅内动脉血管狭窄或闭塞的准确性与CTA相近（P＞0．05）。结论 CE-TCCS可以明显提高颅内动脉的显示率,可以更准确地提示ICVD患者的颅内血管狭窄或闭塞病变,且与CTA诊断结果的一致性较好。