血管内介入治疗脑动静脉畸形

目的 探讨血管内栓塞治疗脑动静脉畸形(AVM)的临床效果和安全性．方法 应用血管内栓塞治疗脑AVMll例，栓塞剂为NBCA，栓塞后3例行手术切除，3例行γ-刀治疗．结果 1例完全栓塞，5例栓塞70％—90％，3例栓塞50％—70％，2例栓塞小于50％．生活、工作完全正常治愈5例，症状明显改善4例，症状无改善2例．结论 血管内栓塞治疗脑AVM的方法是相对安全的，可治愈部分脑AVM，对于大型、重要功能区的脑AVM，血管内栓塞联合手术或放疗可提高治愈率，降低致残率和死亡率．     

Arteriovenous fistula and nerve conduction velocity in patients on hemodialysis: statistical and electrographic findings

The aim of this study was to investigate the possible influence of arteriovenous fistula (AVF) on nerve conduction velocity in patients on intermittent hemodialysis and its relevance to the pathogenesis of carpal tunnel syndrome (CTS). The data on 22 patients showed no statistically significant differences in the electrographic parameters considered. This suggests that AVF by the end-to-end method plays no significant part in the alteration of nerve conduction. Possibly radial steal phenomena, which occur with other types of AVF, are at least partly responsible for the reported cases of CTS.

---

Sommario Scopo di questo studio è stato indagare l'eventuale influenza della fistola arterovenosa (FAV) sulla velocità di conduzione nervosa in pazienti in trattamento emodialitico periodico, per le sue pssibili implicazioni nella patogenesi della sindrome del tunnel carpale (CTS). Vengono presentati i dati relativi a 22 pazienti. I risultati non hanno evidenziato differenze statisticamente significative dei parametri elettrografici considerati.Pertanto i nostri dati suggeriscono che la FAV (eseguita secondo la tecnica termino-terminale) non riveste un ruolo significativo nell'alterazione della conduzione nervosa. È possibile che fenomeni di furto nel territorio dell'arteria radiale, che si verificano con FAV eseguite con altra modalità, siano, almeno in parte, responsabili dei casi di CTS segnalati nella letteratura al riguardo.

     

Anterior displacement of the mandible for better exposure of the distal segment of the extracranial carotid artery

Summary Anterior displacement of the mandible (ADM) was performed in 34 patients undergoing surgery for malformations or atheromatous lesions of the distal segment of the extracranial internal carotid artery (ICA). This procedure greatly facilitates surgical access to the upper cervical region and has several advantages over mandibulotomy-mandibulectomy, namely: A shorter operating time, sparing of the inferior alveolar nerve and of the mandibular branch of cranial nerve VII, with no need for post-operative immobilization of the mandible. ADM permits the correction of ICA lesions extending as far as the first cervical vertebra. For lesions extending into the carotid canal ADM needs to be supplemented by various other procedures via the base of the skull.     

降低终末期肾病患者动静脉内瘘成熟不良率

目的降低终末期肾病患者动静脉内瘘成熟不良率。方法成立品管圈圈组,通过现状调查、原因解析明确问题真因,从制定动静脉内瘘院前指导规范,建立多学科协作模式;实施“VAP”评估模式,制定围手术期标准化管理流程;构建“互联网 +”智能宣教模式,优化院外延伸服务三方面进行改进。结果终末期肾病患者动静脉内瘘成熟不良率由10.6%降低至3.3%。结论开展品管圈活动降低了终末期肾病患者动静脉内瘘成熟不良率。     

脑血管畸形的CT、MRI及MRA诊断(附16例报告)

目的　探讨CT、MRI及MRA在脑血管畸形中的诊断价值。方法　搜集经血管造影和手术病理证实的脑血管畸形16例,包括动静脉畸形(AVM)12例,海绵状血管瘤4例。所有病例均行CT、MRI平扫及MRA检查,MRA采用3D-TOF法。结果　AVM的CT平扫主要表现为低、等或高混杂密度,部分伴钙化,合并急性出血者呈高密度。MRI扫描T     

Multimodal management of ruptured cerebral micro-arteriovenous malformations: A retrospective series of 19 cases and a review of the literature

BackgroundMicro-arteriovenous malformations (micro-AVMs) are defined as AVMs just visible on angiography with a nidus size between 0.5 and 1 cm. Their principal manifestation is intracranial hemorrhage and their diagnosis and therapeutic management are still unclear.MethodsThe aim of our work was to show the clinical presentation, treatment and outcome of ruptured cerebral micro-AVMs in a retrospective cohort study of 19 patients and a systematic review of the literature.ResultsWe obtained a total of 20 micro-AVMs in 19 patients. The mean age was 47.3 years. Clinical presentation was acute bleeding. The mean volume of hematoma was 12.9 mm³ (0 - 60.4), with topographic distribution as follows: 64% cortical with supratentorial bleeding, 26% deep, and 10% in the posterior fossa. Among the 20 micro-AVMs of the series, 11 (55%) had endovascular management, 6 (30%) had surgical treatment and 3 (15%) had GK radiosurgery alone. All of our patients have been cured at the end of the follow up without re-permeabilization. In our series, clinical outcome showed good recovery with a mean score of 4.6 on Glasgow Outcome Scale (GOS). In the literature, 88% of patients had a GOS of 4 or 5.DiscussionIntracerebral hematoma (ICH) was the main clinical manifestation. In the case of negative initial angiographic assessment, patients must have supraselective angiographic exploration. In the case of conservative treatment of hematoma, endovascular obliteration and microsurgical exclusion seems to be reasonable therapeutic options, according to our observations.     

Hemolytic anemia and hexokinase deficiency associated with malformations

Summary Hexokinase deficiency in the red cells caused a hemolytic anemia in a 28 y. old woman who revealed multiple malformations and a latent diabetes mellitus.Supported by Deutsche Forschungsgemeinschaft (Grant Go 236/2).     

The normal vascularization of the intradural filum terminale in man

Summary The arterial and venous blood-supply of the intradural filum terminale was studied microscopically in 18 fresh cadavers after removing the dorsolumbar spinal cord in one piece, with the roots and the filum in their dural sheath. The arteries were examined after manual injection of the artery of the lumbar enlargement, while study of the veins was made without injection since their bluish-black color made them easily identifiable. After gross examination, each specimen was fixed and then sectioned at 12 different levels from the medullary conus to the bottom of the dural sac for histologic study. The distribution of the vascularization the filum terminale appeared constant. A single artery, the artery of the filum, arises from the termination of the anterior spinal axis, either by trifurcation or from the proximal part of one of the 2 branches of the anastomotic ansa of the conus. The artery travels in front of the filum, with rapidly diminishing caliber; rarely, it can be followed into the sacral canal. The vein of the filum travels in front of that structure but behind the artery, as in the cord; its caliber is uniform but varies from subject to subject. It traverses the dura below and continuous with the anterior spinal vein above. No vessels were found on the dorsal aspect of the filum. While the artery of the filum is of a caliber proportional to that of the filum and appears to be a nutrient vessel, the vein has a caliber unrelated to that of the filum and appears rather as an intradural drainage route continuous with the anterior spinal vein. Several cases of disease of the filum terminale confirm this anatomic appearance and also show that, because of the existing hyperpressure in the vein of the filum, the posterior spinal vein also shares in the drainage of the latter and that entire system may function in both ascending and descending directions.

---

La vascularisation normale du filum terminale intradural chez l'homme

Résumé La vascularisation artérielle et veineuse du filum terminale intradural a été étudiée sur 18 cadavres frais, sous microscope, après prélèvement en monobloc de la moelle épinière dorso-lombaire, des racines et du filum dans leur étui dural. L'examen des artères a été fait après injection manuelle de l'artère du renflement lombaire, tandis que l'étude des veines s'est faite sans injection compte tenu d'une coloration bleu-noir spontanée qui les rendent aisément identifiables. Après étude macroscopique, chaque pièce a été fixée, puis coupée à 12 niveaux différents depuis le cône médullaire jusqu'au fond du cul-de-sac dure-mérien, pour étude histologique. La distribution de la vascularisation du FT apparaît constante. Une artère unique, l'artère du FT, naît de la terminaison de l'axe spinal antérieur, soit par trifurcation, soit de la partie proximale d'une des 2 branches de l'anse anastomotique du cône. L'artère chemine devant le FT; son calibre diminue rapidement; rarement, elle a pu être suivie jusque dans le canal sacré. Une veine, la veine du FT, chemine en avant du FT mais en arrière de l'artère, comme au niveau médullaire. Son calibre est uniforme mais variable d'un sujet à l'autre. Elle traverse la dure-mère en bas; elle se continue avec la veine spinale antérieure en haut. Aucun vaisseau n'a été retrouvé à la face dorsale du FT. Si l'artère du FT a un calibre qui est proportionnel à celui du filum et apparaît comme un vaisseau nourricier, la veine a un calibre sans aucun rapport avec le volume de celui-ci et apparaît davantage comme une voie de drainage intradural en continuité avec la veine spinale antérieure. Quelques cas de pathologie du FT confirment cet aspect anatomique et montrent aussi qu'en raison de l'hyperpression veineuse régnant dans la veine du FT, la veine spinale postérieure participe également au drainage de celle-ci et que l'ensemble peut fonctionner dans les 2 sens ascendant ou descendant.

     

胼胝体动静脉畸形的显微手术

目的：总结胼胝体动脉脉畸形（ＡＶＭ）的显微手术治疗经验。方法：回顾分析１９９０年１月至１９９８年１２月治疗８例胼胝体ＡＶＭ的结果。结果：７例行显微手术切除,其中１例行术中ＡＶＭ栓塞加手术切除。全切５例,次分切除２例,无手术死亡。１例扭绝手术,半年后死于再出血。随访５例,平均随访２６月,均恢复良好。绫：胼胝体ＡＶ－经诊断明确,应积极行显微手术切除。对难以全切者可行栓塞治疗或栓塞后切除。对深部术后部分     

Experimental study and clinical use of poly(vinyl acetate) emulsion as liquid embolisation material

A new material, an emulsion of poly(vinyl acetate) was experimentally developed and clinically used to overcome several disadvantages in currently used liquid embolisation materials. The emulsion microparticles, 0.3–0.7 m in size, possessed cationic charge on the surface and hence aggregated immediately on contact with fluids containing anions. This inert polymer has the advantage that it does not induce a deleterious reaction in living tissue. Moreover, its medium is water and it is not adhesive, like the cyanoacrylates. Several concentrations of emulsion were injected into the renal arteries of dogs. For the investigation of tissue reactions and the possibility of recanalisation, the emulsion was injected into rats both subcutaneously and into the renal arteries. The renal artery injections in dogs showed adequate radiopacity and consistent complete occlusion. The lower the concentration of the emulsion, the smaller the arteries which could be occluded. Even at very low concentrations, however, venous occlusion did not occur. Histological study of the embolised rat kidney revealed no detectable damage in the vessel wall and no recanalisation for up to 6 months. The subcutaneously injected PVAc emulsion elicited mononuclear cell infiltration and gradual centripetal fibrosis, without any deleterious effect on the surrounding tissue. A cerebral arteriovenous malformation (AVM) was embolised using the material. Histology of the resected nidus showed findings similar to those in the animal experiments.