经皮血管成形术治疗内瘘管狭窄

目的 应用经皮血管成形术(PTA)治疗动静脉内接管狭窄，探讨治疗内接管狭窄的新途径。方法 血液透析患者两例，均出现血液透析时内接管血流量不足。选择患者肘动脉为穿刺点，18G针头为穿刺针，0．09cm导丝，7F鞘管，优微显为造影剂。造影确定狭窄部位后，选择与紧邻狭窄区上游或下游的正常血管直径相近的扩张气囊，将扩张气囊在荧屏监视下置于狭窄区，用充满50％稀释的造影剂的压力计进行充气，压力缓慢增加致狭窄在气囊作用下消失，其边缘与未狭窄部位完全平行。扩张持续时间为15秒，压力为15个大气压。结果 经皮腔内血管成形术后，即感血管震颤较扩张前明显增强，第二天透析时血流量明显增加，可完全满足透析需要。接管使用半年余，血流量持续维持在2Mmymjn，未发生扩张部位再狭窄。结论 PTA是治疗动静脉内瘘狭窄的有效方法之一，操作简单，创伤小，可选择适宜患者采用。     

牛津郡社区卒中分型患者脑动脉狭窄的分布

目的分析急性脑梗死（ACI）患者的牛津郡社区卒中项目（OCSP）各分型的颅内外动脉狭窄分布情况。方法根据OCSP分型，将835例患者分为完全前循环梗死（TACI）、部分前循环梗死（PACI）、腔隙性梗死（LACI）和后循环梗死（POCI），其中356例患者采用数字减影血管造影术评价临床症状对侧的颅内外动脉狭窄情况。结果在356例患者中，TACI组的颈内动脉颅外段50％以上狭窄的发生率高于其他三型（P〈0．05）；38．9％（35／90）PACI患者、43．7％（28／64）POCI患者、43．6％（24／55）TACI患者和45．6％（67／147）LACI患者存在颅内动脉50％以上狭窄，且四组间比较差异无统计学意义（P〉0．05）。结论临床症状对侧的颈内动脉颅外段50％以上狭窄与OCSP分型相关，TACI组患者比其他三型更易出现颈内动脉颅外段狭窄。     

Biliary cystic intraductal papillary mucinous tumor and cystadenoma/cystadenocarcinoma: differentiation by CT

Purpose To identify differential findings of biliary cystic intraductal papillary mucinous tumor (IPMT) and biliary cystadenoma/cystadenocarcinoma on CT images. Materials and methods Records of 7 patients with biliary cystic IPMT and 17 patients with biliary cystadenoma/cystadenocarcinoma were accessed. A pathologist reviewed gross morphologic and microscopic findings and confirmed the diagnosis. Two radiologists who were blind to the pathologic diagnosis reviewed CT images regarding size of cystic mass, mural nodule, septa, calcification, dilatation of the proximal, and distal bile ducts to the tumor, and the results were analyzed using multivariate analysis. Results Mural nodule and dilatation of the bile ducts distal to the cystic tumor were more commonly seen in patients with cystic IPMT than in patients with biliary cystadenoma/cystadenocarcinoma and these are statistically significant, the P values being 0.029 and 0.016, respectively. Size of the cystic tumor, presence of septa, calcification, and dilatation of the bile duct proximal to the cystic tumor were not statistically different. Conclusion Biliary cystic IPMT could be differentiated from biliary cystadenoma/cystadenocarcinoma on CT images based on the presence of mural nodules and dilatation of the bile ducts distal to the cystic tumor.     

Gemcitabine-releasing polymeric films for covered self-expandable metallic stent in treatment of gastrointestinal cancer

Non-vascular drug-eluting stents have been studied for the treatment of gastrointestinal cancer and cancer-related stenosis. In this study, we designed and evaluated a gemcitabine (GEM)-eluting covered nonvascular stent. Polyurethane (PU)/polytetrafluoroethylene (PTFE) film was selected for the drug loading and eluting membrane. The membrane was fabricated by dip-coating on a Teflon bar (∅; 10 mm), air-dried, peeled off and applied to a self-expanding Nitinol stent. Various amounts of poloxamer 407 (PL, Lutrol^® F127, BASF) (8%, 10%, or 12% of PU by weight) were added to control the release of GEM from membranes. The membrane containing 12% PL (GEM-PU-PL12%) showed the most favourable release properties; 70% of the loaded GEM released within 35 days, including the 35% released during the initial burst. The biological activities of GEM-PU-PL12% were evaluated using human cholangiocarcinoma cells (SK-ChA-1). GEM-PU-PL12% most efficiently inhibited the proliferation of cholangiocarcinoma cells and most highly induced pro-inflammatory cytokines (TNF-α, IL-1β and IL-12) and p38 MAPKs in the cells. Subtumoural insertion of the GEM-PU-PL12% membrane more efficiently inhibited the growth of CT-26 colon cancer than other membranes. In this study, the GEM-eluting metal stents covered with PU-PL12% showed considerable feasibility for the treatment of malignant gastrointestinal cancer as well as cancer-related stenosis.     

High resolution 3 Tesla contrast-enhanced MR angiography of the hands in Raynaud’s disease

Raynaud’s disease is associated with disorders in blood circulation of the hands. The gold standard to visualise pathology of digital arteries is catheter angiography. Contrast-enhanced MR angiography (CE MRA) has developed even more as an alternative non-invasive method to digital subtraction angiography, mostly for pelvic or lower limb vessels. We report a case of primary Raynaud’s disease with high-grade stenosis and an occlusion of the digital arteries. This case illustrates the benefit and efficiency of CE MRA at high fields in depicting location and extension of peripheral arterial alterations.     

Potential and limitations of wave intensity analysis in coronary arteries

Wave intensity analysis (WIA) is beginning to be applied to the coronary circulation both to better understand coronary physiology and as a diagnostic tool. Separation of wave intensity (WI) into forward and backward traveling components requires knowledge of pulse wave velocity at the point of measurement, which at present cannot accurately be determined in human coronary vessels. This prompted us to study the sensitivity of wave separation to variations in wave speed. An estimate of wave speed (SPc) was calculated based on measured distal intracoronary pressure and Doppler velocity in normal and diseased coronary vessels of patients during hyperemia. Changes of the area under separated WI waveforms were determined for a range of wave speeds from 25 to 200% of the calculated value. Variations in wave speed between half to twice the calculated value did not substantially alter separated WI. In conclusion, although SPc lacks accuracy in determining local coronary wave speed it is within limits still applicable for wave separation in coronary WIA.     

Double contrast small-bowel radiography in the preoperative assessment of Crohn’s disease: Is it still useful?

PURPOSE: To evaluate the usefulness of double contrast small-bowel radiography (SBR) in the preoperative assessment of patients with Crohn's disease (CD). METHODS: Thirty-nine consecutive patients who underwent surgery for CD between 2000 and 2004, preceded by a preoperative small-bowel series evaluation, were enrolled in our study. The radiologic findings were compared with the intraoperative findings. RESULTS: Small-bowel radiography was associated with good specificity and sensitivity for the detection of stenosis. Although its main limitation was a remarkable overestimation of stenosis, the main indications for surgery were always confirmed. Sensitivity and specificity were lower for the detection of internal fistulas and the correlation was significant only for SBR performed within 3 months of the operation; however, the concordance between radiological and operative findings was greater. No correlation was observed for the detection of an abdominal mass. CONCLUSIONS: Small-bowel radiography is still reliable for evaluating stenoses and internal fistulas. However, magnetic resonance imaging or computed tomography is mandatory to evaluate an abdominal mass.