Maternal mortality in Greece, 1996-2006

Objective

To present retrospective data for maternal deaths in Greece from 1996 to 2006.

Methods

Demographic information and information on the causes of death was provided by the Hellenic Statistical Authority. Maternal deaths were assessed by cause of death, maternal age, and place of residence. The maternal mortality ratio (MMR) was estimated and expressed as the number of deaths per 100 000 live births.

Results

From 1996 to 2006, 29 deaths were attributed to pregnancy and childbirth, yielding a total MMR of 2.63. The leading cause of direct deaths was hemorrhage and that of indirect deaths was cardiac disease. There was a borderline significant decline in the MMR during the study period. The MMR was significantly higher at the extremes of the reproductive age range.

Conclusion

Maternal mortality in Greece is low; however, no formal data have been published since 1996. Knowledge of the causes of maternal death can lead to the prevention of maternal deaths and safer motherhood.     

羊水与自体血培养后刺激花生四烯酸代谢物的释放

目的：探讨人羊水在体外刺激自体血细胞释放前列环素（PGI₂）、血栓素A₂（TXA₂）和白三烯C₄（LTC₄）等花生四烯酸代谢物的作用。方法：取产妇羊水与自体血进行培养,用放射免疫分析法检测血中血栓素B₂（TXB₂）和6-酮前列腺素F_1α（6-Keto-PGF_1α）的含量,用酶联免疫法检测LTC₄。结果：羊水能刺激血细胞释放TXA₂和LTC₄,胎粪污染的羊水作用更为明显。TXB₂的含量由加羊水培养前的(63.5±52.0) ng/L增加到培养后的(189.1±102.0) ng/L（P<0.01）,用胎粪污染羊水与血培养后增加到(289.2±113.2) ng/L（P<0.01）;LTC₄的含量由培养前的(40.1±39.7) ng/L增加到培养后的(293.5±206.1) ng/L（P<0.01）,胎粪污染组增加到(387.2±214.6)ng/L（P<0.01）,但前列环素仅有轻度增加,无显著性差异(P>0.05)。结论：羊水能刺激血细胞释放花生四烯酸类生物活性物质,使其正常的平衡状态被破坏,可能与羊水栓塞的发生机理有关。     

三维数字减影血管造影在颅内动脉瘤诊疗中的应用价值

目的：探讨3D—DSA在颅内动脉瘤诊断和治疗中的应用价值。方法：对蛛网膜下腔出血患者常规行DSA检查，发现病变或可疑病变后行3D—DSA检查。结果：26例颅内动脉瘤中检出动脉瘤31枚，其中后交通9枚，C1段3枚，C2段5枚，C3段3枚，前交通6枚，大脑中3枚。椎动脉动2枚。3例2D—DSA未见病变3D—DSA确诊，5例因血管重叠3D—DSA排除了动脉瘤。6枚GDC栓塞，5枚手术夹闭，2枚颈内动脉可脱性球囊封阻术。结论：3D—DSA极大提高了脑血管造影检查的准确性和可靠性，为动脉瘤的介入治疗和手术夹闭提供了可靠保障，在临床诊疗中具有很高的应用价值。     

Evaluation of Retrievability of the Gunther Tulip Vena Cava Filter

Purpose To evaluate the feasibility and safety of withdrawal of a Gunther tulip retrievable vena cava filter (GTF). Methods Between June 2001 and December 2005, at our institution 86 GTFs were implanted for temporary caval filtration in 59 patients (37 women, 22 men; mean age 59.3 years, range 18–87 years). For GTFs retrieved thereafter, we retrospectively reviewed the following parameters: rate of success in retrieval, degree of trapped thrombus in the filter, and complications during retrieval. Results Worsening of or new development of pulmonary embolism after filter implantation did not occur in any patient. Of the 86 GTFs implanted, retrieval of 80 was attempted. Among those 80 filters, 77 (96%) were successfully retrieved (with the standard method, n = 72; with the modified method, n = 5) without any complication. The period of implantation of the retrieved filters was 13.4 ± 4.2 days. In the 5 filters that were filled to a height of ≥ 1/4 with trapped thrombus, retrieval was performed after attempts were made to decrease trapped thrombi. In addition, a temporary filter or another GTF was temporarily placed at the cephalad level of the GTF during this removal procedure. Conclusion GTFs can be retrieved in the majority of cases. Even when encountering situations in which the filter could not be removed using the standard method, withdrawal was possible in a high frequency of cases through various trials using modified methods.     

脑脂肪栓塞的MRI及CT诊断

目的 总结脑脂肪栓塞(CFE)的临床及MRI及CT的影像特点。方法 分析3例急性CFE的临床表现、影像特点。结果 (1)3例均为长骨骨折，在外伤后或骨折固定、复位数小时后突发精神状态改变。(2)醒状昏迷是主要临床表现。(3)3例患者MRI能明确显示病灶，1例CT显示了病灶。(4)MRI、CT显示脑内病灶均呈基本对称性分布，为边缘模糊的点、片状长T1、长T2信号，CT呈低密度。病灶均累及脑干、分水岭区脑白质、基底节区、胼胝体压部。2例病灶累及小脑。(5)1例患者发病康复治疗3个月后MRI复查示脑内病灶完全消失。结论 急性脑脂肪栓塞的临床及MRI、CT影像改变具有特征性，MRI在病灶显示上优于CT。     

Gunther Tulip Inferior Vena Cava Filter Placement During Treatment for Deep Venous Thrombosis of the Lower Extremity

Purpose To evaluate the efficacy and safety of Gunther tulip retrievable vena cava filter (GTF) implantation to prevent pulmonary embolism during intravenously administered thrombolytic and anticoagulation therapy and interventional radiological therapy for occlusive or nonocclusive deep venous thrombosis (DVT) of the lower extremity.Methods We evaluated placement of 55 GTFs in 42 patients with lower extremity DVT who had undergone various treatments including those utilizing techniques of interventional radiology.Results Worsening of pulmonary embolism in patients with existing pulmonary embolism or in those without pulmonary embolism at the time of GTF insertion was avoided in all patients. All attempts at implantation of the GTF were safely accomplished. Perforation and migration experienced by one patient was the only complication. Mean period of treatment for DVT under protection from pulmonary embolism by the GTF was 12.7 ± 8.3 days (mean ± SD, range 4–37 days). We attempted retrieval of GTFs in 18 patients in whom the venous thrombus had disappeared after therapy, and retrieval in one of these 18 cases failed. GTFs were left in the vena cava in 24 patients for permanent use when the DVT was refractory to treatment.Conclusion The ability of the GTF to protect against pulmonary embolism during treatment of DVT was demonstrated. Safety in both placement and retrieval was clarified. Because replacement with a permanent filter was not required, use of the GTF was convenient when further protection from complicated pulmonary embolism was necessary.     

创伤性肾动静脉瘘的介入治疗

目的 评价用介入技术治疗创伤性肾动静脉瘘(RAVFs)的安全性和疗效。方法 对8例不适宜做外科治疗的RAVFs患者进行了介入治疗，其中外伤性损伤4例，医源性损伤4例。6例行经导管超选择性肾动脉内钢丝圈栓塞术，2例行被覆膜支架置入患侧肾动脉内封闭瘘口。结果 血管造影显示肾内型动静脉瘘4例，累及肾动脉段-亚段级分支；主干(肾外)型动静脉瘘4例。治疗均获成功，治疗结束时复查血管造影显示瘘口被封闭。轻微并发症1例。医源性RAVFs患者术后失血症状迅速改善，肉眼血尿消失；4例术前存在心脏负荷过度症状患者，闭塞动静脉瘘后症状迅速改善，血管杂音消失。术后肾功能测定均属正常范围，其中2例肾动脉被覆膜支架置入患者，同位素肾扫描显示患侧肾脏形态、功能正常。术后随访10～42个月，2例分别于术后10，18个月死于与RAVFs无关的疾病。6例仍然生存，一般情况良好，未再针对RAVFs进行外科或介入治疗。结论 介入技术，包括经导管超选择性肾动脉内栓塞术和被覆膜支架置入术，是治疗创伤性、复杂型RAVFs的安全、有效的方法。     

急性肾出血的介入治疗

目的 :探讨急性肾出血的血管造影及栓塞治疗的应用价值。方法 :对 40例急性肾出血病例采用Seldinger技术经皮股动脉穿刺插管行血管造影 ,选用不同的栓塞材料闭塞出血动脉。结果 :选择性肾动脉造影明确了出血的部位、程度及相关血管的情况 ,为栓塞治疗提供了依据 ,40例肾出血患者栓塞后出血完全停止 ,并保留了患肾的部分组织和功能。结论 :选择性肾动脉造影与栓塞是急性肾出血可靠的诊断方法 ,也是安全、有效的止血手段 ,并对保留患肾泌尿功能有重要意义。     

动脉栓塞联合冷冻消融对晚期肾癌患者免疫功能的影响

目的探讨选择性肾动脉栓塞术(transcatheter renal arterial embolization,TRAE)联合氩氦冷冻消融治疗对晚期肾癌患者外周血CD4+、CD25+调节性T细胞(Treg)的影响及临床意义。资料与方法晚期肾癌患者44例,分别于治疗前、后1～6个月取外周血,流式细胞仪检测外周血T淋巴细胞亚群(CD3+T、CD4+T、CD8+T、CD4+T/CD8+T、NK细胞、Treg细胞)变化情况;术后1个月采用增强MRI或CT或正电子发射体层摄影(PET-CT)评价肿瘤坏死情况。结果治疗后3个月Treg细胞比例[(3.36±1.12)%]与术前[(4.75±1.66)%]比较明显降低,差异具有统计学意义(t=16.865,P<0.01);CD3+T、CD4+T、CD4+T/CD8+T、NK细胞比例较术前明显增高,CD8+T细胞比例明显降低(P<0.01)。治疗后3～6个月CD3+T、CD4+T、CD4+T/CD8+T、NK、CD8+T、Treg细胞比例无明显变化,呈稳定趋势(P>0.05)。治疗后Treg细胞比例下降程度与肿瘤负荷下降程度呈正相关(r=0.944,P<0.01)。结论晚期肾...     

Subtypes and proportions of cerebrovascular disease in an autopsy series in a Japanese Geriatric Hospital

Summary Of 1721 consecutive autopsies performed on patients over 60 years of age in Tokyo Metropolitan Geriatric Hospital, 550 (32% of all autopsied cases) revealed symptomatic cerebrovascular lesions. Among the 550 patients, intracranial hemorrhage was found in 19%, cerebral infarction in 75%, and coexisting cerebral hemorrhage and cerebral infarction in 6%. Twenty-eight percent of the cerebral infarctions were embolic infarctions of cardiac origin, half of which were caused by nonvalvular atrial fibrillation, and 69% were nonembolic infarctions of cardic origin. Progressive subcortical vascular encephalopathy accounted for 15% of the cerebral infarctions. Two-thirds of all lobar cerebral hemorrhages were amyloid angiopathy-related. Nonvalvular atrial fibrillation is the most important cardiac source of embolic stroke. Progressive subcortical vascular encephalopathy is one of the characteristic features of ischemic lesions, and cerebral amyloid angiopathy is an important cause of lobar cerebral hemorrhage in the aged.This work was supported in part by Grant-in-Aid for Cooperative Research No. 63304039, The Ministry of Education, Science and Culture, Japan