兔烫伤后动脉壁脑啡肽含量的变化

目的：研究兔烫伤早期发生多器官功能衰竭时，动脉壁脑啡肽含量的变化及其意义。方法：兔乙醚吸入法全身麻醉后，以95℃水烫伤其背部及躯干两侧30s，造成30％体表面积Ⅲ度烫伤(Ⅲ度30％TBSA)。测定烫伤48h后的平均动脉血压、中心静脉压、心输出量，计算总外周阻力、心指数；测定血中肌酸磷酸激酶、谷丙转氨酶、尿素、肌酐、血小板等反映心、肺、肝、肾功能的一系列指标。用放射免疫测定法测定动脉脑啡肽的含量。结果：烫伤后48h肠系膜动脉、肾动脉、肺动脉中亮氨酸脑啡肽的含量明显减少。血流动力学指标中平均动脉血压无明显变化，总外周阻力明显增高，心脏指数明显下降。心、肝、肾功能下降达到衰竭标准，肺功能下降，动物发生MOF。给烫伤动物应用钠洛酮以后，动物的心脏指数明显改善，血管总外周阻力下降。但是，多脏器功能衰竭的各项指标均未见改善。结论：烫伤后动脉壁内源性脑啡肽含量减少，可能是外周微血管痉挛收缩，全身总血管阻力增高，脏器功能损害的原因之一。     

Causes of Arterial Bleeding After Living Donor Liver Transplantation and the Results of Transcatheter Arterial Embolization

Objective

To analyze the causes of arterial bleeding after living donor liver transplantation (LDLT) and to evaluate the efficacy of transcatheter arterial embolization (TAE).

Materials and Methods

Forty-two sessions of conventional arteriography were performed in 32 of the 195 patients who underwent LDLT during the past 2 years. This was done in search of bleeding foci of arterial origin. TAE was performed with microcoils or gelatin sponge particles. The causes of arterial bleeding, the technical and clinical success rates of TAE and the complications were retrospectively evaluated.

Results

Forty-two bleeding foci of arterial origin were identified on 30 sessions of arteriography in 21 patients. The most common cause of bleeding was percutaneous procedures in 40% of the patients (17 of the 42 bleeding foci) followed by surgical procedures in 36% (15/42). The overall technical and clinical success rates of TAE were 21 (70%) and 20 (67%) of the 30 sessions, respectively. The overall technical success rate of TAE for the treatment of bleeding from the hepatic resection margin, hepatic artery anastomotic site and hepaticojejunostomy was only 18% (2/11), whereas for the treatment of bleeding in the other locations the technical and clinical success rates of TAE were 100% and 95%, respectively. No procedure-related major complications occurred.

Conclusion

In the case of arterial bleeding after LDLT, percutaneous procedure-related hemorrhages were as common as surgery-related hemorrhages. There were technical difficulties in using TAE for the treatment of hepatic arterial bleeding. However, in the other locations, TAE seems to be safe and effective for the control of arterial bleeding in LDLT recipients.     

获得性动-静脉瘘的介入微创治疗

目的 评价用介入微创技术治疗获得性动一静脉瘘(AVF)的安全性和疗效。方法 对10例不适宜传统外科治疗的AVF患者进行介入治疗,包括肾动-静脉瘘4例、髂动-静脉瘘3例、锁骨下动-静脉瘘3例。致病原因为穿通性损伤5例、医源性损伤3例、恶性肿瘤和小肠Crohn病各1例。就诊时临床表现有肢体肿胀-静脉显露6例、局部血管杂音10例、心脏负荷增加10例、右心功能衰竭2例、血尿4例。3例用经导管超选择性栓塞,7例用被覆膜支架置人封闭瘘口。结果 10例患者均治疗成功,治疗结束时复查血管造影显示瘘口被封闭。轻微并发症3例,无严重并发症。术后患者局部肿胀、静脉充血、心脏负荷过度等症状迅速改善,血管杂音消失;肾脏AVF患者,术后肾功能测定属于正常,其中2例肾动脉被覆膜支架置入患者同位素肾扫描显示患侧肾脏形态-功能正常。术后随访6个月至6年。3例患者分别于术后6、9、14个月死于与AVF无关的疾病;2例于术后3周、2个月因AVF复发,在原支架区再次置入一个被覆膜支架后残留瘘口闭塞;2例于术后6、8个月复查造影显示支架区存在轻度狭窄。7例患者仍然生存,未再针对AVF进行外科或介人治疗。结论 介入微创技术,包括超选择性栓塞和被覆膜支架置入术,是治疗获得性、复杂型AVF安全有效的方法。     

骨盆骨折动脉损伤的影像学研究及临床治疗

目的探讨骨盆骨折动脉损伤的影像学特点及动脉栓塞的方法。方法自1999年1月至2005年6月，收治因骨盆骨折致血流动力学不稳患者60例。男42例，女18例；年龄21—52岁，平均34．5岁。交通伤32例，压砸伤13例，坠落伤9例，其他伤6例。入院时均处于休克状态，常规摄骨盆后前位、出口位及入口位x线片。在抗休克治疗同时，行髂动脉造影。结果后环骨折25例，损伤血管64支；前环骨折13例，损伤血管17支；髋臼骨折6例，损伤血管12支；混合骨折16例，损伤血管36支。1例髂总动脉血栓形成行人造血管移植；4例髂外动脉损伤，3例血栓形成（1例行手术取栓，1例行溶栓再通术，1例未处理），1例破裂行修复术；50例为髂内动脉及其分支损伤出血，行动脉栓塞；5例未发现明显血管损伤。3例死亡。结论根据骨盆骨折x线表现可预测血管损伤类型，后环骨折容易引起臀上动脉、骶外侧动脉及髂腰动脉损伤，前环骨折易损伤闭孔动脉，最易损伤的动脉是臀上动脉。栓塞出血动脉的断端及其吻合支是最佳的治疗方法。     

A simplified method for continuous hepatic arterial port-catheter system placement not requiring catheter end-hole occlusion

Purpose: To evaluate the efficacy of hepatic port-catheter system placement without distal catheter tip occlusion or gastroduodenal artery embolization distal to the catheter tip.

Material and Methods: A port-catheter system was percutaneously implanted in 29 patients (16 men, 13 women; mean age 65.6 years) with unresectable liver cancer. Persistent blood flow through the end hole of the catheter was verified immediately and 1-10 days after catheter placement.

Results: In all cases, percutaneous port-catheter placement was successfully performed. In seven of 29 (24.1%) patients, flow through the end hole of the catheter was verified immediately after the procedure. However, no flow was seen 1-10 days after the procedure.

Conclusion: It is not necessary to occlude the end hole of the catheter tip and embolize the gastroduodenal artery beyond the catheter tip when placing a port-catheter system for repeated hepatic arterial infusion chemotherapy.     

Bail-out intracranial stenting with Solitaire AB device after unsuccessful thrombectomy in acute ischemic stroke of anterior circulation

Background

Recent trials established the efficacy of mechanical stent-retriever thrombectomy for treatment of stroke patients with large vessel occlusion (LVO) in the anterior circulation. However, stent-retriever thrombectomy may not accomplish successful recanalization in all patients. The aim of this study is to report the role of bail-out permanent stenting after failure of mechanical thrombectomy.

The nutrient artery canal of the femur: a radiological study in patients with primary total hip replacement

Objective Plain antero-posterior and lateral radiographs of the femur often show radiolucent lines, which may reflect the canal of a nutrient artery. In patients who have undergone total hip replacement these radiolucent lines must be differentiated from fractures caused by bursting of the shaft during the procedure.Design and patients In a retrospective radiological study 129 extremities of 95 patients with cementless primary hip prostheses were examined for radiolucent lines. Pre- and postoperative antero-posterior and lateral radiographs were analyzed.Results In 34 of 129 extremities (26.4%) radiolucent lines compatible with a nutrient artery canal were detected, 14 of which (10.9% overall) were seen on lateral radiographs. In 11 of 129 extremities (8.5%) a nutrient artery canal was detected only on the antero-posterior views, while in 9 of 129 extremities (7.0%) it was well defined in both projections. One patient (0.8%) presented with a fracture postoperatively, which was radiologically distinct from a nutrient artery canal. The distance between the tip of the greater trochanter and the proximal end of the nutrient artery canal was 170±25 mm; the canal length was 27±9 mm.Conclusion Nutrient artery canals are often seen radiologically on pre- and postoperative radiographs down to the mid-shaft level and should be routinely recorded.     

Angiodysplasia of the right colon treated by embolization with ivalon (polyvinyl alcohol)

Angiodysplasia of the colon is being recognized with increasing frequency as a source of lower gastrointestinal bleeding in the elderly. In one patient with colonic angiodysplasia, superselective segmental embolization of the ileo-colic artery with Ivalon resulted in the cessation of bleeding without causing bowel infarction. However, because of the development of collateral branches to the angiodysplastic malformation, bleeding recurred. While colectomy remains the treatment of choice in younger patients, in high risk patients embolization with a permanent embolic material, such as Ivalon, is an attractive alternative.     

肠系膜动脉瘤破裂出血的诊治分析：附8例报告

背景与目的 肠系膜动脉瘤是一种罕见的疾病,大部分患者确诊时动脉瘤已出现破裂大出血,病情危重,治疗风险大。本文回顾性分析肠系膜动脉瘤破裂患者的病例特点,探讨该疾病诊断和治疗方式的选择。方法 回顾性分析于2016年1月—2020年12月在湖南省郴州市第一人民医院血管外科收治的8例肠系膜动脉瘤破裂出血患者的临床资料和随访情况。结果 8例患者行腹部CTA或腹部增强CT明确诊断为肠系膜动脉瘤破裂出血。患者均行急诊手术治疗,其中6例行腹腔动脉造影+栓塞术;1例因腔内治疗失败后选择行开放手术;1例首选开放手术。8例患者均抢救成功,3例患者腔内治疗术后出现腹痛腹胀,药物保守治疗好转;1例患者开放手术术后出现创伤性胰腺炎,予以药物治疗治愈。所有患者住院期间均无再出血、肠缺血、肠坏死等并发症与再次手术。8例患者均随访12个月,患者正常饮食后无腹痛腹胀不适,无再次出血;复查腹部增强CT或CTA提示动脉瘤栓塞良好,血肿明显吸收。结论 临床医生要提高对肠系膜动脉瘤破裂出血疾病的认识和警惕,及时做出正确诊断。手术治疗方案可分为开放手术和腔内治疗,均安全和有效,术前应根据患者病情、瘤体位置和形态决定具体手术方案。     

Large-Bore Aspiration Thrombectomy versus Catheter-Directed Thrombolysis for Acute Pulmonary Embolism: A Propensity Score–Matched Comparison

PurposeTo compare effectiveness and safety of large-bore aspiration thrombectomy (LBAT) with catheter-directed thrombolysis (CDT) for treatment of acute massive and submassive pulmonary embolism (PE).Materials and MethodsThis retrospective review included patients with acute PE treated with LBAT or CDT using tissue plasminogen activator (tPA) between December 2009 and May 2020. A propensity score based on Pulmonary Embolism Severity Index class and PE severity (massive vs submassive) was calculated, and 26 LBAT cases (age 60.2 y ± 17.1, 14/26 women) were matched with 26 CDT cases (age 59.7 y ± 14.2, 14/26 women).ResultsThe CDT group had 22.1 mg ± 8.1 tPA infused over 21.2 h ± 6.6. Both groups demonstrated similar initial and final systolic pulmonary artery pressure (PAP) (LBAT: 54.5 mm Hg ± 12.9 vs CDT: 54.5 mm Hg ± 16.3, P = .8, and LBAT: 42.5 mm Hg ± 14.1 vs CDT: 42.6 mm Hg ± 12.1, P = .8, respectively) and similar reductions in heart rate (LBAT: −5.4 beats/min ± 19.2 vs CDT: −9.6 beats/min ± 15.8, P = .4). CDT demonstrated a higher reduction in Miller score (−10.1 ± 3.9 vs −7.5 ± 3.8, P = .02). LBAT resulted in 1 minor hemorrhagic complication and 2 procedure-related mortalities, and CDT resulted in 1 minor and 1 major hemorrhagic complication.ConclusionsLBAT and CDT resulted in similar reductions of PAP and heart rate when used to treat acute PE. CDT reduced thrombus burden to a greater degree. Although hemorrhagic complications rates were not significantly different, the LBAT group demonstrated a higher rate of procedure-related mortality. Larger studies are needed to compare the safety of these techniques.