心内科抗凝老年患者静脉留置针穿刺部位及留置长度探讨

目的探讨心内科抗凝老年患者静脉留置针不同穿刺部位及留置长度的临床效果。方法 196例心内科抗凝老年患者分为对照组(A1组、 A2组)和观察组(B1组、 B2组),选择不同穿刺部位及留置长度进行静脉留置针穿刺,观察各组的留置时间、不良事件发生情况。结果 B2组的留置针平均留置时间显著长于A2组,不良事件发生率显著低于A2组(P <0.05)。结论对于心内科抗凝老年患者,前臂中1/3段穿刺并保留导管2 mm在体外,能延长留置时间,降低不良事件发生率。     

兔后腔静脉血栓形成后血小板膜糖蛋白CD62p、CD63的表达变化

目的:研究兔后腔静脉血栓形成后对血小板膜糖蛋白CD62p、CD63表达的影响。方法:实验兔55只,随机分血栓形成组(T组)、假手术组(S组)、正常对照组(N组),分别于术后1、3、7、14、28天采静脉血行流式细胞术,测血小板CD62p、CD63的表达水平。结果:CD62p在T组1、37、、14、28天的阳性表达率分别为(1.00±0.34)%、(1.27±0.50)%(、2.57±0.45)%、(1.13±0.6)%、(0.29±0.11)%,CD63的阳性表达率则为(1.59±0.52%)、(3.53±1.28)%(、2.37±0.45)%(、2.79±1.81)%(、2.21±0.56)%,与S组、N组比较差异具有显著性;CD62p和CD63两者之间存在正相关性(r=0.362,P<0.01)。结论:CD62p、CD63是检测血小板活化的敏感、特异的指标,其表达在血栓形成7天内呈显著增高,在7天以后逐渐下降。     

Reversible tonsillar prolapse in vein of Galen aneurysmal malformations: report of eight cases and pathophysiological hypothesis

We report eight cases of vein of Galen aneurysmal malformation (VGAM) assoicated with a Chiari type I malformation. In four cases magnetic resonance imaging (MRI) or computed tomography performed in the neonatal period did not demonstrate the posterior fossa anomaly, which appeared on later scans. In the other cases the MRI was performed in infancy and the anomaly was already present. We compared the venous phases of the posterior fossa angiograms and the MRI in these patients. In all eight cases, the angiograms showed a reflux in the cerebellar veins, via the petrous vein, associated with a uni-or bilateral stenosis or thrombosis of the distal posterior dural sinuses. Furthermore, in two cases the posterior fossa returned to normal on MRI following endovascular treatment, while in three cases the herniation of the cerebellar tonsils decreased after the embolization. Tonsillar prolapse becomes irreversible when the venous outlet is incapable of taking the flow even when the VGAM has been treated adequately. In eight additional cases of VGAM for which MRI and angiogram studies were available and in which stenosis or thrombosis of posterior dural sinuses was present without tonsillar prolapse, no reflux into the cerebellar veins was shown. We suggest that the posterior fossa hydrovenous congestion is a result of inadequate venous drainage and that the tonsillar descent is reversible if adequate venous drainage is reconstituted following therapeutic embolization of the fistula. Tonsillar prolapse is not a consequence of mass or raised intraventricular pressure. Our observation suggests that in some other conditions, the Chiari I malformations may be secondary to early hydrovenous dysfunction of the posterior fossa.     

Prevention of postoperative venous thromboembolism following laparoscopic cholecystectomy

Advantages of laparoscopic cholecystectomy are less patient discomfort and shorter hospital stay than with the traditional open approach. Nevertheless, this operation is performed under general anesthesia, using muscle relaxants and pneumoperitoneum, with most patients in the reverse Trendelenburg position. It has been shown that this procedure is associated with significant hypercoagulability and dilation of the veins of the leg. We review the role of these factors as potential risk factors for the development of postoperative venous thromboembolism and also report the rate of thromboembolic complications following laparoscopic cholecystectomy. Based on the available evidence, it is concluded that laparoscopic cholecystectomy, despite being a minimally invasive procedure, may be associated with a definite risk of developing postoperative venous thromboembolism that could extend beyond hospital discharge. Accordingly, thrombosis prophylaxis should be considered for these patients.     

Uptake and localisation of O-(β-hydroxyethyl)-rutosides in the venous wall,measured by laser scanning microscopy

Summary The uptake and localisation of O-(-hy-droxyethyl)-rutosides (HR) in the venous wall was studied in 8 patients undergoing crossectomy for a varicose long saphenous vein. The fluorescence of cross-sections of the vein wall was measured by laser scanning microscopy, based on the autofluorescence of HR. Four patients (treated group) received 2 × 1.5 g HR IV before surgery, and four (untreated patients) served as controls.Uptake of HR into the veins from treated patients was seen, with a mean fluorescence intensity of 80.9 units compared to 49.4 units in the untreated veins. The increase in fluorescence was clearly demarcated on the endothelial side of the vein wall.It is concluded that HR passes into the vascular wall, where it is localised in the endothelial and sub-endothelial areas.     

保留颈外静脉同期双侧颈淋巴结清除术治疗头颈部癌

自１９８９年１月至１９９４年１２月对１９例头颈部癌并双侧颈淋巴结转移的病人采取保留颈外静脉同期双侧颈淋巴结清除术（以下简称颈清术）治疗。包括喉癌、下咽癌、舌癌、口底癌、甲状腺癌及双侧原发灶不明的颈部转移癌。本文对其手术指征及手术方法作了简单介绍，并对其意义及可行性进行了讨论。     

浅静脉离心穿刺留置套管针应用观察

目的 探索浅静脉离心穿刺留置套管针应用的可行性。方法 采用自身对照法，选择100例18-76岁患者左右手背浅静脉血管作为研究对象。对照组（右手）采用向心穿刺留置套管针；观察组（左手）采用浅静脉离心穿刺留置套管针。比较两组平均最大输液流速、最长置管时间、静脉炎发生次数等。结果 观察组平均最大输液流速明显快于对照组，最长置管时间明显长于对照组（P均〈0．05）；静脉炎发生次数少于对照组，但两组间差异无显著意义（P〉0．05）。结论 浅静脉离心穿刺留置套管针是一种可行、有效的穿刺方法。     

静脉药瘾者心内膜炎11例临床分析

目的探讨静脉药瘾并发感染性心内膜炎(infective endocarditis IE)的特征。方法回顾分析11例静脉药瘾并发IE的临床资料。结果静脉药瘾并发IE者多为青年男性,男女比例10∶1,平均年龄26岁,无基础心脏病。临床特点起病为发热,体温38~40℃,为不规则发热,全身乏力,面色苍白,咳嗽气促,合并肺感染(91%);血细菌培养阳性以金黄色葡萄球菌多见(45.3%);超声心动图显示右心系统感染(三尖瓣受累)最为常见(81%),其次二尖瓣(18%)。结论静脉药瘾并发IE者临床特征为发热、咳嗽、气促,心脏杂音,血细菌培养阳性合并肺感染,超声心动图检查对右心感染有重要价值。     

Stem cell therapy with skeletal myoblasts accelerates neointima formation in a mouse model of vein graft disease

Although still a matter of controversial discussion, skeletal myoblasts are one of the options for stem cell transplantation improving cardiac function after myocardial infarction, exhibiting several advantages including the availability, the ability of self-renewal and differentiation, and the lack of ethical and immunological problems. The aim of this study was to investigate the impact of stem cell therapy with skeletal myoblasts on experimental venous bypass grafts in a mouse model of vein graft disease.Forty C57BL/6J mice underwent bypass grafting interposing a venous bypass graft of the donor mouse into the carotid artery of the recipient mouse.Twenty mice received periadventitially treatment with 1 million fluorescence labeled skeletal myoblasts suspended in culture medium (treatment group), the other twenty mice received only culture medium without myoblasts (control group).Two weeks after bypass surgery, the vein grafts of all 40 mice were harvested, stained and histologically investigated under light and immunofluorescence microscope.Against our expectations, skeletal myoblasts stayed in place and were still located in the adventitia after bypass grafting. Additionally, vein grafts of the myoblast group revealed a 2fold increased neoneointima formation, a decreased media thickness, a slightly increased neovascularization, a higher percentage of reendothelialization and also a slightly higher percentage of PDGFR ɑ, PDGFR ß, MMP-7 and MMP-9 positive cells, suggesting a paracrine mechanism responsible for accelerated neointima formation.In conclusion, the results of our study do not support the use of skeletal myoblast for the treatment of vein graft disease after coronary artery bypass surgery.     

超声在肠系膜上静脉血栓治疗过程中的应用价值

目的:在肠系膜上静脉血栓治疗过程中,超声用于评价疗效和指导治疗的价值。方法:肠系膜上静脉血栓住院治疗的8例患者,超声连续观察肠系膜上静脉内径,血栓回声;肠系膜上动脉血流速度及阻力指数;水肿肠管的长度,肠壁厚度;周围小血管情况;腹腔积液的量等指标,评价治疗效果,指导临床。结果:8例肠系膜上静脉血栓的患者,根据临床资料,结合超声指征,3例手术治疗,其中1例术后第2天死亡,其余术后症状明显缓解,超声呈逐渐恢复表现。5例保守治疗,超声征象改善,症状逐步缓解,出院。结论:超声实时、动态观察肠系膜上静脉血栓治疗中的声像图变化,及时评价治疗效果,为临床提供直接证据,指导治疗。