45例肾血管肌脂瘤的治疗

目的：探讨肾血管肌脂瘤的治疗方法。方法：４５例患者中２３例未作特殊治疗;６例超选择性动脉栓塞治疗、７例行肿瘤剜除术或肾部分切除术、９例行全肾切除术。结果：随访２１例,平均随访时间３．６ａ。未作特殊治疗的病例中未发现肿瘤破裂出血,２便肿瘤体积增大但我症状;超选择性动脉栓塞病例无症状复发、无破裂出血、肾功能稳定。手术患者均保持肾功能稳定,无肿瘤复发。结论：对本病采取保守性治疗原则。超选择肾动脉栓塞是简     

Flexible tantalum stents: Effects in the stenotic canine urethra

Purpose Evaluate the effects of flexible tantalum stents (Strecker) implanted into stenotic canine urethras.Methods Eight conditioned, adult, German shepherd dogs, weighing 30–40 kg, were used. Strictures were created surgically in the bulbar urethra just proximal to the os penis. Two months postsurgery, strictures were documented radiographically and then balloon dilated. Following dilatation, a single Strecker stent was placed across the stricture. Stents were 7 mm in expanded diameter and either 2 or 4 cm in length. Retrograde urethrography was performed immediately after stent placement and then biweekly for up to 12 months. Two dogs were sacrificed at 2, 4, 6, and 12 months post-stenting, and necropsy was performed. The urethra was excised, fixed, and examined by scanning electron and light microscopy.Results Clinical success was achieved without complications in all animals. Hyperplasia of the urothelium was noted 4–6 weeks after stent placement and was most pronounced at 4–6 months. Mucosal folds were found between the stent struts. Restenosis occurred at the distal end of the stent in one dog. Histological alterations were noted in the deeper layers of the urethral wall.Conclusion Strecker stents were well tolerated in all animals and seem useful for the treatment of urethral strictures.Presented at CIRSE Annual Meeting and Postgraduate Course, Budapest, June 20–24, 1993     

Prognostic value of the Spetzler's grading system in a series of cerebral AVMs treated by a combined management

Summary The prognostic value of the Spetzler's grading system is studied in a series of 52 AVMs treated by a combined management, using one or several of the 3 available techniques: surgical resection, endovascular embolization, radiosurgery.The symptoms at the time of treatment were haemorrhage 50%, seizures 31%, headache and deficit 19%. Three grade groups were considered: I and II (31%), III (33%), IV and V (36%). Overall, AVMs were managed as follows: resection alone 25%, embolization plus resection 23%, embolization alone 23%, radiosurgery with various combinations 29%. According to the grade groups, the most frequently used technique was resection alone for grade I–II AVMs (44%), radiosurgery for grade III AVMs (41%) and embolization alone for grade IV–V AVMs (42%).The clinical outcome was evaluated in terms of deterioration due to treatment. The best results were obtained in grade I–II AVMs (81% with no deterioration) then in grade III AVMs (65%) and in grade IV–V (58%). However, when we consider the outcome in terms of favourable results (no or only minor deterioration) we obtained a similar outcome for grade I–II and grade III AVMs (94% each), and only 79% for grade IV–V malformations. The angiographic outcome showed a better eradication rate in grade III AVMs (88% complete eradication), than in grade I–II AVMs (75%) and in grade IV–V (47%).Our conclusion is that the Spetzler's grading system in this series was well correlated with both the clinical and the angiographic outcome. However, we found no real difference between grade I–II and grade III AVMs. So, in terms of prognostic value, the grade I, II, and III AVMs could be considered together as low-grade malformations, with a better prognosis than the high-grade malformations (grade IV and V).     

肝癌介入治疗药动学及其临床意义探讨

本研究通过测定血清阿霉素浓度,分析了原发性肝癌阿霉素肝动脉灌注(A 组)、阿霉素碘油乳化后栓塞(B 组)及阿霉素微囊栓塞化疗(C 组)后药动学变化及其临床意义。A 组药动学变化与静脉给药相似,但峰值浓度高。B 组峰浓度低,半衰期延长,显示缓释和降低血浓度的作用。C 组峰浓度不明显,表现为长时、稳定的释放,血浓度低,具有保持局部长时间高浓度作用。结果揭示了肝癌介入治疗不同给药方法疗效差异的药动学依据。     

白及微球的研制及其肝动脉栓塞实验研究

用乳化－冷凝技术首次制备出白及微球,并通过正交实验,确定了制备特定粒径微球的最佳工艺条件。对微球的外观、粒径与分布、溶胀度及血液相容性等进行了研究。微球平均粒径为５４．３６μｍ,粒径范围５０～９０μｍ,占总数的７８．３７％;微球在ｐＨ＝７．４的缓冲液中有一定的溶胀性;血液相溶性良好。实验小猪微球栓塞后的肝动脉造影表明白及微球可致肝右动脉一级、二级分支完全栓塞;病理检查表明梗死区可见肝组织呈肝硬化改变,大量的假小叶形成。微球栓塞后,ＧＰＴ有一过性升高,３周后恢复正常。实验结果表明,以白及胶为材料制备的微球将为癌症的治疗提供一种新型的栓塞治疗剂     

超声引导经皮穿刺冷冻治疗肝癌的实验和临床研究

目的 探讨经皮穿刺冷冻治疗原发性肝癌的应用价值。方法 ①家猪１２只,腹腔镜下显露肝脏,ｒｏｃａｒ针穿刺腹壁,经一非金属鞘将冷冻头插入肝右叶冷冻;②１１例原发性肝癌,超 引导穿刺扩张皮肤直至肝内肿瘤表面,保留一非金属鞘,ＬＣＳ－２０００冷冻机５ｍｍ冻冷头经鞘管插至肿瘤中心冷冻。结果 ①实验动手术后无腹腔内出血,冷冻穿刺部位无严重冻伤;②１１例病人冷冻后恢复均顺利,其中５例肿瘤缩小≥５０％,１例肿瘤完     

ITP患者脾动脉栓塞前后血小板的检测及其临床意义

应用自动血细胞计数仪检测ＩＴＰ患者脾动脉栓塞前后不同时期血小板的变化。结果栓塞后患者血小板计数（ＰＬＴ）和平均血小板体积（ＭＰＶ）的变化呈负相关,但ＰＬＴ恢复正常后,ＭＰＶ仍高于正常。提示脾动脉栓塞后血小板计数增高的机理不同于激素治疗。     

Preliminary experience with interactive guided brain biopsies using a vertically opened 0.5-T MR system

The purpose of our study was to evaluate the feasibility and accuracy of brain biopsies performed within a vertically opened MR system. We worked with the interventional 0.5-T MR “SIGNA SP” (General Electric Medical Systems, Milwaukee, Wis.) with an integrated tracking device “Flashpoint Position Encoder” (Image Guided Technologies, USA). As a holding device for this instrument we constructed a special frame. The whole system allows an exact adjustment of an optimum biopsy direction and guidance of the biopsy in a non-stereotactic, interactive mode in near real-time. As biopsy tools we used MR-compatible aspiration and specially made side-cut needles (Daum, Germany; E-Z-EM, USA). We performed a prospective diagnostic brain biopsy study in 18 patients. Guidance of the needle was carried out using gradient-echo single-slice technique. The sample was taken after controlling the exact position of the needle tip on spin-echo images. In 12 cases an exact neuropathological diagnosis was possible. In 6 cases of negative biopsy (4 aspiration biopsies) the samples were not representative. Our results demonstrate the feasibility of interactive MR-guided minimally invasive brain biopsies in an open MR system. The best results were achieved using cut needles for biopsies of contrast-enhancing lesions visible on T1-weighted gradient-echo guidance sequence. Received: 2 February 1998; Revision received: 13 July 1998; Accepted: 2 September 1998     

镍钛合金支架治疗食管良、恶性狭窄(附10例报道)

目的;研究镍钛合金支架在食管良,恶性狭窄治疗中的应用,方法;本组１０例患者,食管癌９例,贲门失弛缓症１例,均采用镍钛合金支架,在Ｘ线监视下,经口腔进行置入术。结果：全组支架均一次置入成功,支架入后,患者吞咽困难明显改善,总有效率为１００％,追踪观察,有３例食管癌患者,肿瘤分别突向支架腔内及支架上,下端生长,再次引起狭窄,其中１例又加置一个支架,使食管狭窄再次开通。结论：采用镍钛合金支架治疗食管良,     

New aspects in the treatment of priapism

Recent advances in the understanding of erectile physiology have improved the prompt diagnosis and treatment of priapism. During initial assessment, the physician must distinguish between veno-occlusive low flow (ischemic) and arterial high flow (nonischemic) in order to choose the correct treatment option for each type of priapism. Patient history, physical examination, penile haemodynamics and corporeal metabolic blood quality assist the distinction between static and dynamic priapism. Normally, priapism is effectively treated with intracavernous vasoconstrictive agents or surgical shunting. However, when these two methods fail, subsequent treatment procedures are a matter for debate. Alternative options, such as intracavernous injection of methylene blue or selective penile arterial embolization, for the management of high and low flow priapism are described and a survey of current treatment modalities is presented.