Successful choledochojejunostomy for choledochal stricture with preservation of the collateral parabiliary venous system following iatrogenic portal occlusion

We surgically treated a patient with biliary stricture and portal vein occlusion, after operation for gastric cancer with lymphadenectomy along the hepatoduodenal ligament, that had led to choledochal stone formation and a dilatated parabiliary venous system. A 57-year-old man without hepatic dysfunction exhibited hepatic duct dilatation with choledochal stone on ultrasonography and percutaneous transhepatic cholangiography, respectively. Pharmacoportography revealed occlusion of the portal vein and dilatation of the parabiliary venous system. Of various preoperative imaging studies used, enhanced computed tomography was most useful for delineating the surgical anatomy of the hepatoduodenal ligament. Complete preservation of the dilatated vessels, which functioned as the main portal collateral pathway, resulted in a successful choledocho-jejunostomy, with an uneventful postoperative course.     

Therapeutic Consequences of Variation in Intraarterial Pressure Measurements After Iliac Angioplasty

Purpose: To assess the accuracy of intraarterial measurement of transstenotic pressure gradients for the detection of hemodynamically suboptimal iliac angioplasty. Methods: In 14 patients, referred for diagnostic angiography, mean pressure gradients in the aorta and iliac artery were obtained twice, using a double-sensor pressure catheter. Additional iliac measurements were performed during pharmacologically induced flow augmentation. Repeatability was assessed by calculation of the mean difference plus standard deviation (MD ± SD) and repeatability coefficient (2 × SD). These results were extrapolated to 137 iliac angioplasty procedures with secondary stenting where there was a residual pressure gradient > 10 mmHg. Results: MD ± SD for repeated measurements at rest and during flow augmentation were 0 ± 2 mmHg and 1 ± 3 mmHg, respectively. Repeatability coefficients were 3 and 6 mmHg. Mean pressure gradients after hemodynamically insufficient angioplasty were 8 ± 7 mmHg at rest and 17 ± 5 mmHg following vasodilatation. Inaccurate pressure recordings may have led to inappropriate stent placement in less than 2.5%, and inappropriate denial of stent placement in less than 5% of the lesions. Conclusion: Variability of intraarterial pressure measurements has little consequence in the detection of hemodynamically significant stenosis after angioplasty. Received: 0/00/00/Accepted: 0/00/00     

小鼠不完全性脑缺血、再灌注时脑膜血流量的变化及尼莫地平的作用

目的：观察双侧颈总动脉阻断后脑血流的变化。方法：结扎双侧颈总动脉观察小鼠不完全性脑缺血及其再灌注时脑膜血流量的变化。结果：结扎颈总动脉后小鼠脑膜血流量在几秒钟内骤然下降，血流量较结扎前降低约８５．９％±６．４５％。同时血管中红细胞运动近停滞状态，血管再通时脑血流处于低灌注状态，血流量下降３４．４７％±１１．６９％，此时脑缺血再灌后脑组织实际上处于一种慢性缺血状态。再灌注１０ｄ后，小鼠脑海马ＣＡ１区神经细胞数明显减少。尼莫地平可以解除再灌注时的脑血流低灌状态。并防止由此所引起的脑海马ＣＡ１区神经细胞的缺失。结论：缺血后及时给予尼莫地平具有积极的治疗意义。     

无创伤性测定门静脉压力与肝血流二法联合应用研究肝硬化的价值

目的　为临床研究肝硬化提供有价值的手段。方法　采用99mTc -RBC测定 93例肝硬化患者肝血流 ,选择峰时 (Tmax) ,半廓清时 (T1/2 )、廓清率 (K值 )、肝血流 (LBF)等作为观察指标 ,与正常对照组比较 ;同时用99mTc-MIBI经直肠给药测定其中 5 4例患者门静脉压力 (PVP) ,以心 /肝 (H/L)比值作为分流指数。结果　肝硬化组Tmax、T1/2 、K及LBF分别为 1.2 6± 0 .99(93)min、5 .75± 3.38(93)min、0 .15 4± 0 .116 (93)及 0 .6 10± 0 .2 89(93)L/min ,除Tmax外 ,与对照组均有非常显著性差异 ;Child -A、B、C级各组之间 (除Tmax外 )也均有非常显著性差异或显著性差异 ;Child -A、B、C级各组H/L分别为 0 .49± 0 .18(2 1)、0 .6 9± 0 .16 (15 )、0 .91± 0 .2 1(18) ;PVP分别为 2 .2 2± 0 .5 7(2 1)kPa、2 .85± 0 .38(15 )kPa及 3.5 4± 0 .6 5 (18)kPa。而对照组的H/L及PVP分别为 0 .30± 0 .12 (16 )及 1.6 1± 0 .38(16 )kPa。Child -A、B、C级各组分别与对照组及各组之间比较 ,除Child -B与C级组PVP无显著性差异 (P >0 .0 5 )外 ,其余均有非常显著性差异 (P <0 .0 1)及显著性差异 (P <0 .0 5 )。结论　本法测定肝血流及门脉压力方便 ,无创伤 ,对分析病情 ,判断疗效 ,指导制订治疗方案 ,估计预后等均有较     

Cortical circumferential profile of SPECT cerebral perfusion in Alzheimer''s disease

We developed a semiautomatic method termed “cortical circumferential profiling” for objective analysis of cerebral cortex function in emission tomographic neuroimaging studies. This method treats cortex as a continuous ring near the outer brain edge. A computer algorithm samples the cortex at 60 contiguous, equiangular locations, using 1-cm² samples. These values are plotted as a function of cortical angle to produce the cortical circumferential profile. This method was used in a study of regional cerebral perfusion in 15 patients with Alzheimer's disease and 8 elderly control subjects using N-isopropyl [I-123]-iodoamphetamine. Cortical circumferential profiling decreases variability, examines the entire cortex within slices at preselected levels above the orbital-meatal line, and facilitates intrasubject and intersubject comparisons.     

普拉固和鱼油对高胆固醇血症患者血脂与心脑血管事件影响的比较

目的:比较普拉固和鱼油对高胆固醇血症患者的血脂、血粘度、血管内皮功能和心脑血管事件的影响。方法:对266例原发性高胆固醇血症患者经2周洗脱期后,随机分为两组,普拉固组,初服10mg,每晚一次,8周后若TC仍>5.2mmol/L,LDL—ch>3.12mmol/L,则加量至20mg/d,每8周再查血脂,以达到TC<5.2mmol/L,LDL—ch<3.12mmol/L的量作治疗量继续服用。鱼油组,服美国深海鱼油一日三次,一次3g,均于服药8周复查血脂、血粘度及血管内皮功能等并作16月随访。结果:治疗8周,TC,普拉固组下降26％,鱼油组下降12％(P<0.01)。LDL—ch,普拉固组下降31％,鱼油组下降11％(P<0.01),肱动脉流量介导的舒张与硝酸甘油介导的舒张,普拉固组分别增加104％和19％,鱼油组无明显改变。全血低切粘度,普拉固组减少23％,鱼油组减少10％(P<0.01)。平均随访16月,普拉固组中脑出血1例(0.8％),鱼油组发生心脑血管事件7例(5.3％),死亡1例(P<0.05)。两组均无明显的不良反应。结论:普拉固是一个安全有效的降脂药,能改善血管内皮功能,降低血粘度,减少高胆固醇血症病人心脑血管事件发生。     

Blood velocity assessment using 3D bright-blood time-resolved magnetic resonance angiography.

Blood velocity is a functional parameter that is not easily assessed noninvasively, especially in small animals. A new noninvasive method that uses magnetic resonance angiography (MRA) to measure blood flows is proposed. This method is based on the time-of-flight (TOF) phenomenon. By initially suppressing the signal from the stationary spins in the area of interest, it is possible to sequentially visualize only the signal from the moving spins entering a given volume. With this method, 3D cine images of the blood flow can be generated by positive contrast, with unparalleled spatial (<200 microm) and temporal resolutions (<10 ms/image). As a result, it is possible to measure flow in sinuous paths. The present method was applied in vivo to measure the blood velocity in mouse carotid arteries. Because of its robustness and simplicity of implementation, this method has numerous potential applications for fundamental studies in small animal models.     

Ischemia independent lesion evolution during focal stroke in rats

Lesion evolution during focal cerebral ischemia may depend on flow restrictions or on accumulation of toxic mediators within the infarct and expansion of these factors to the periinfarct region. So far, the precise contribution of flow dependent versus spreading-mediated impairment of viable periinfarct tissue has not been determined. Therefore, we measured lesion expansion, flow restrictions and glutamate distribution on serial brain sections at different time points after experimental focal ischemia.Permanent focal ischemia was induced by occlusion of the right middle cerebral artery in male rats and the flow reduction was subsequently measured at 1, 12 and 24 h using iodo[¹⁴C]antipyrine autoradiography. Additionally, the necrotic volume was determined on serial brain sections and the glutamate content was measured in tissue samples from adjacent microdissections.Twelve hours after focal ischemia no noteworthy viable areas with blood flow restrictions of 20-40 ml 100 g^− 1 min^− 1 existed but at 24 h the necrotic tissue exceeded the hemodynamically compromised region by 40 ± 21 mm³ (24%). Furthermore, at 12 and 24 h the glutamate content was elevated in areas surrounding the infarct.Relevant flow restrictions are detectable only during early stages of infarct maturation, whereas the propagation of secondary factors may be the predominant mechanism for delayed infarct evolution.