全植入式药泵行肝血管灌注治疗晚期肝癌

对２４例不能切除的晚期肝癌采用完全植入式药泵行肝动脉和门静脉双灌注化疗。结果：部分缓解（ＰＲ）１５例（６２．５％），稳定（Ｓ）８例（３３．３％），进展（Ｐ）１例。平均生存期为９．１７月，半年生存率为６６．７％，１年为２５％。在ＡＦＰ＞４００μｇ／Ｌ的１０例中，５例下降。     

可控性丝线留置术治疗体表难治性海绵状静脉畸形的实验及临床研究

目的研究可控性丝线的致栓效果及其治疗体表难治性海绵状静脉畸形的初步疗效。方法将丝线一端留置于不同管腔大小的静脉内,另一端挂于血管壁埋于皮下,实现其可控性,用经过不同处置的丝线,分别留置于兔耳缘静脉、股静脉,观察其引起血管栓塞的效果。选择致栓效果较好的丝线组,用于临床治疗难治性体表海绵状静脉畸形的患者。结果几种经不同处置的丝线,均能不同程度地起到闭塞血管的作用,对于管腔稍大,血流较快的静脉(兔股静脉),浸泡丝裂霉素并打结的丝线组,致栓效果最好;临床初步应用证实,可控性丝线治疗体表难治性静脉畸形,安全有效。结论可控性丝线静脉内留置术,是一种安全、有效、损伤小、操作简便的治疗体表难治性海绵状静脉畸形的新方法。     

长脉冲Nd:YAG激光非侵入性治疗皮肤浅表静脉畸形

目的前瞻性研究长脉冲1064nm Nd:YAG激光非侵入性治疗皮肤浅表静脉畸形的疗效。方法22例不同部位皮肤浅表静脉畸形患者接受长脉冲1064nm Nd:YAG激光治疗,6mm直径光斑,7～8ms双脉宽,脉冲间隔20ms,140～150J/cm2能量,接触式冷却,治疗间隔3周至1个月,治疗后1、6个月随访,评价病灶清除率分为五级。结果22例患者完成治疗,最多治疗5次。随访6个月,96.3%浅表静脉畸形获得76%～100%的清除,37%获得病灶的完全清除,未见复发。治疗部位无一例发生紫癜,治疗后8例(38.1%)出现红斑,1d至1个月消退。无色素改变和形成。结论长脉冲1064nm Nd:YAG激光能有效安全地治疗皮肤浅表静脉畸形,选择性地清除浅表血管,并使用接触冷却系统保护表皮,减少紫癜发生及色素改变和瘢痕的形成,达到理想的美容效果。     

磁共振成像对脑静脉畸形的诊断价值

目的 探讨磁共振成像各种方法对脑静脉畸形的诊断价值。方法 收集本院6例脑静脉畸形病例，均进行过磁共振T1WI、T2WI扫描，其中部分病例做过DWI、T2FLAIR、MRA、MRV、T1WI增强扫描及DSA。结果 幕上4例，幕下2例，T1WI、T2WI表现：引流静脉均为流空的低信号，深髓静脉为细条状长T1、长T2信号。其中1例DWI引流静脉及深髓静脉区域低信号；1例T2 FLAIR引流静脉流空的低信号，深髓静脉高信号；2例MRA均阴性，但MRV显示深髓静脉汇入引流静脉；2例T1 WI增强扫描：深髓静脉呈轮辐状汇入引流静脉；1例DSA：动脉期阴性，静脉期见典型的“海蛇头”征。结论 磁共振能明确诊断脑静脉畸形，T1WI增强扫描及MRV均较敏感，DSA为诊断脑静脉畸形金标准。     

Compliance with recommended prophylaxis for venous thromboembolism: improving the use and rate of uptake of clinical practice guidelines

Summary.  Although several authoritative, evidence-based, guidelines for the prevention of venous thromboembolism (VTE) have been published, the use of VTE prophylaxis in routine clinical practice varies markedly. Even in orthopedic surgery, the indication for which prophylaxis is used most often, a significant proportion of surgeons do not use routine prophylaxis. When prophylaxis is used, guideline recommendations are often not followed. A number of factors may contribute to the under-use of guidelines. Physician-related factors include: a lack of awareness of, or familiarity with, the guidelines; a perception that VTE is not a significant problem or that VTE prophylaxis is ineffective; and concern about potential bleeding risks. The guidelines may also be perceived to be too complicated or difficult to apply in a routine manner. In addition, a lack of facilities or resources may also present a barrier to implementation of the guidelines. A number of strategies are being investigated in an attempt to improve compliance with guidelines for VTE prophylaxis. For example, the Investigators Against Thromboembolism (INATE) initiative has developed a simplified pocket guideline on VTE prophylaxis in orthopedic and trauma surgery in order to raise awareness of the current guideline recommendations.     

Cerebral perfusion during human liver transplantation

Summary. During transplantation of the liver cerebral perfusion was monitored by transcranial Doppler determined middle cerebral artery mean flow velocity (V_mean) and pulsatility index (PI) in six fulminant hepatic failure patients and 11 patients with chronic liver disease. In both groups of patients V_mean, PI and central haemodynamic variables were recorded during (1) the last preanhepatic hour; (2) the anhepatic phase; (3) the first 15 min of reperfusion; and (4) for the following 45 min of reperfusion. No significant differences were detected between the two groups of patients with respect to changes of variables with time. The V_mean (40±13 cm s^-1 [mean±SD]), thoracic electrical impedance (TI) (30±7 Ohm), heart rate (97±19 beats min^-1), mean arterial pressure (84±9 mmHg) and arterial carbon dioxide tension (PaCO₂, 4.5±0.4 kPa) remained stable in the anhepatic phase, while cardiac output (CO, 7.6±2.7 to 5.4±1.41 min^-1), stroke volume (SV, 79±26 to 56±15 ml) and PI (1.2±0.3 to 0.9±0.2) decreased (P<0.05). During reperfusion, CO (9.9±4.01 min^-1), SV (105±40 ml), Pa_CO2 (5.5±0.6 kPa), Vmean (57±17 cm s^-1) and PI (1.2±0.2) became elevated. Taken together, during the anhepatic phase of the liver transplantation a maintained central blood volume as indicated by the constant TI served for a stable blood pressure and in turn cerebral perfusion, whereas revascularization of the graft increased cerebral perfusion concomitant with an elevated carbon dioxide tension.     

Recurrent cerebral venous infarcts and superior vena cava obstruction: case report

Abstract We report a patient with repeated venous infarcts in the occipital lobe and occlusion of the superior vena cava. The pathogenetic relationships between the superior vena cava occlusion and the brain infarcts are discussed. High pressure in the superior venous territory and incomplete patency of the transverse sinus are probably responsible for the venous infarcts. Received: 12 July 1996 Accepted: 27 August 1996     

超声显像诊断下肢深静脉血栓的临床应用

目的：探讨超声诊断下肢深静脉血栓的临床价值。方法：应用ＨＰ８５００多功能彩超仪，７．５ＭＨｚ线阵探头，外周血管软件检查临床疑下肢深静脉血栓３２例，另取１２例正常人２４条下肢深静脉作对照。２ＤＵＳ显示形态学改变，ＣＶＩ及ＰＷ模式观察血流状态。结果：超声检出下肢深静脉血栓形成２５例，除外血栓形成７例。２ＤＵＳ显示血栓形成部位血管内径明显增大，与患者健侧同水平深静脉内径进行配对ｔ检验，ｔ＝１３．８２，Ｐ