High-Density Circumferential Pulmonary Vein Mapping with a 20-Pole Expandable Circular Mapping Catheter

The differentiation of pulmonary vein (PV) electrograms from atrial far-field signals during PV isolation (PVI) for atrial fibrillation (AF) may be difficult. In addition, owing to highly variable PV ostial sizes, current fixed-diameter circular PV mapping catheters may not yield optimal electrograms. We evaluated an expandable, circular 15–25 mm diameter, 20-pole mapping catheter for PV mapping during sustained AF in 25 patients. After selective PV angiography to define the ostial position and size, the catheter was introduced into each PV and withdrawn to the most stable proximal position, with optimal wall contact ensured by progressive loop expansion. At each PV ostium, electrograms recorded at high resolution (HR) were compared with those recorded at a resolution similar to that of a standard 10-pole Lasso catheter. After PVI performed during ongoing AF, the presence of residual far-field potentials (FFP) under both set-ups was compared. We mapped 97 PV, including 4 pairs with common ostia. In the HR recordings, the PV potentials had greater amplitude (0.5 ± 0.1 vs 0.3 ± 0.1 mV, P = 0.001) and fragmentation, whereas left atrial FFP were minimized. After successful isolation of all PV, FFP were observed in 33% of left superior and 28% of left inferior PV on the HR recordings, compared to 66% and 61%, respectively under normal resolution. Catheter stability and optimal wall contact, in combination with HR electrograms can optimize circumferential PV mapping during AF and improve the discrimination of FFP postablation.     

Partial Portal Vein Ligation Plus Thioacetamide: A Method to Obtain a New Model of Cirrhosis and Chronic Portal Hypertension in the Rat

To obtain a new model of chronic portal hypertension in the rat, two classical methods to produce portal hypertension, partial portal vein ligation and the oral administration of thioacetamide (TAA), have been combined. Male Wistar rats were divided into four groups: 1 (control; n?=?10), 2 [triple partial portal vein ligation (TPVL); n?=?9], 3 (TAA; n?=?11), and 4 (TPVL plus TAA; n?=?9). After 3 months, portal pressure, types of portosystemic collateral circulation, laboratory hepatic function tests (aspartate aminotransferase, alanine aminotransferase, bilirubin, alkaline phosphatase, and gamma-glutamyl transpeptidase) and liver histology were studied. The animals belonging to group 2 (TPVL) developed extrahepatic portosystemic collateral circulation, associated with mesenteric venous vasculopathy without hepatic destructurization or portal hypertension. Animals from group 3 (TAA) developed cirrhosis and portal hypertension but not extrahepatic portosystemic collateral circulation, or mesenteric venous vasculopathy. Finally, the animals from group 4 (TPVL?+?TAA) developed cirrhosis, portal hypertension, portosystemic collateral circulation, and mesenteric venous vasculopathy. The association of TPVL and TAA can be used to obtain a model of chronic portal hypertension in the rat that includes all the alterations that patients with hepatic cirrhosis usually have. This could, therefore, prove to be a useful tool to study the pathophysiological mechanisms involved in these alterations.     

Traumatic Injury of the Superior Mesenteric Vein: Ligate,Repair or Shunt?

Abstract We report a case of SMV injury in a critically ill patient. The patient was a 19-year-old woman involved in a motor vehicle collision. Her injuries included grade II splenic and renal lacerations, devascularized and lacerated right and transverse colon, a transected transverse mesocolon, a massive shear injury of her abdominal wall, and two partial SMV transections. At initial damage control laparotomy, the SMV was ligated, the devascularized bowel resected and a temporary abdominal closure applied. At re-operation, a mesocaval shunt using saphenous vein was employed. The shunt failed and the patient required a saphenous vein jump graft. Although visceral vascular injuries are rare, ligation of the SMV in a damage control situation is acceptable. This case study is the first to discuss appropriate treatment when interruption to a patient's collateral visceral venous drainage limits the surgeon’s ability to ligate. In these situations, bypass shunts may be successful.     

腔内激光治疗大隐静脉曲张192例报告

目的 探讨腔内激光治疗大隐静脉曲张的疗效。方法 2004年7月～2006年3月我院对192例238条肢体大隐静脉曲张行高位结扎、激光烧灼静脉主干和小腿曲张静脉。小腿局部严重曲张的静脉团,另做切口做局部切除或点状抽拨。结果 本组一次治愈率96.2%（229/238）。9例9条肢体术后因仍有少量曲张静脉存在,局麻下行切除或再次激光治愈。114例大隐静脉主干及小腿局部条索状硬结、疼痛;9例皮肤灼伤。术后住院时间4～8 d,平均5.6 d。158例随访1～18个月,平均11.6月,未见复发。结论 腔内激光治疗大隐静脉曲张效果确切,创伤小。     

Percutaneous coronary intervention in two occluded arms of a saphenous 'Y'-graft: the importance of protecting both of your arms.

Percutaneous intervention in saphenous vein grafts (SVG) carries a higher risk of distal embolization than intervention in a native vessel, and use of a distal protection device has been shown to improve the outcomes in SVG interventions. We describe an intervention done in an unexpected 'Y' SVG which required dual distal protection with Filterwires placed in both limbs of the diseased graft and which was performed via a 6 Fr guide catheter.     

留置超滑乳胶气囊导尿管并发症的原因分析及对策

目的探讨留置超滑乳胶气囊导尿管并发症的原因及对策。方法对586例留置超滑乳胶气囊导尿管患者进行观察,回顾分析。结果留置超滑导尿管并发症与导尿方法、规范操作、留置导尿管的时间及相关知识宣教有关。结论严格无菌操作,选择合适的导尿管、缩短留置尿管的时间是降低并发症的重要措施。     

门静脉主干缩窄法制备SD大鼠门静脉高压症模型时最佳口径的探讨

目的 探讨缩窄门静脉主干法制备SD大鼠门静脉高压症模型时的最佳缩窄口径.方法 SD大鼠70只,随机分为正常组和6个实验组,每组各10只.正常组行假手术.各实验组分别按照5、6、7、8、9、12号针头的缩窄口径行门静脉主干缩窄术.观察各组大鼠术后累积死亡率,术后状态,术前、术后即刻及术后2周时的门静脉压力,术后2周时的食管组织学变化和脾指数.结果 5、6、7、8、9、12号针头缩窄组术后3 d时大鼠的累积死亡率分别为100%、80%、70%、20%、10%、0%,与缩窄程度正相关.8、9、12号组的大鼠存活状态明显好于5、6、7号组.5、6、7、8、9、12号组术后即刻门静脉压力分别为:(5.836±0.275)、(4.557±0.419)、(3.856±0.576)、(3.343±0.433)、(2.708±0.309)、(1.957±0.358)kPa,7、8、9、12号组术后2周时门静脉压力分别为:(2.163±0.424)、(1.956±0.172)、(1.841±0.202)、(1.232±0.154)kPa,均较正常(0.881±0.165)kPa显著升高(P＜0.05).术后2周,7、8、9、12号组大鼠食管下段黏膜下层平均血管数目分别为:(3.94±0.83)、(3.58±0.63)、(3.14±0.64)、(2.02±0.62)个,与正常组(1.65±0.62)个比较,除12号组外均有增多(P＜0.01);固有层平均血管数目分别为:(2.24±0.64)、(2.05±0.29)、(1.52±0.28)、(0.93±0.19)个,与正常组(0.82±0.18)比较,除第12组外均增多(P＜0.01);黏膜下层血管口径分别为:(4.52±1.51)、(4.05±1.23)、(3.75±1.11)、(2.03±0.86)μm,除第12组外均增大(P＜0.01);脾指数分别为:(4.21±0.93)、(4.06±0.68)、(3.84 4±0.71)、(3.31±0.69)除12号组外也较正常增加(P＜0.01).结论 缩窄门静脉主干可成功制成大鼠门静脉高压症模型;其最佳缩窄口径应该是:大鼠体重200 g左右时用8号针头(直径0.8mm),大鼠体重300 g左右时用9号针头(直径0.9 mm).     

包含颈外静脉的颈阔肌肌皮瓣修复口腔癌切除后缺损

目的探讨将颈外静脉包含在颈阔肌肌皮瓣内修复口腔癌切除后缺损的手术方法。方法先形成蒂在颌缘下包含颈外静脉的颈阔肌肌皮瓣，待口腔肿瘤切除后，将肌皮瓣经口底隧道引入口腔修复缺损。结果临床应用17例，肌皮瓣均无血运障碍，100％存活，其中有2例发生口面痿，经换药后痿口完全闭合。结论将颈外静脉包含在颈阔肌肌皮瓣内有助于肌皮瓣血循环的改善和存活率的提高。     

血红素抑制内皮细胞损伤的形态学观察

目的 探讨血红素对人脐静脉内皮细胞氧化应激损伤的保护作用。方法 将培养的人脐静脉内皮细胞进行分组：对照组、损伤组、血红素组。观察各组细胞在光、电镜下形态学的改变。结果 在光镜下，血红素组细胞的生长状态明显优于损伤组；在电镜下，损伤组细胞核固缩，而血红素组细胞核幼稚，核仁明显。结论 在人脐静脉内皮细胞中，血红素对过氧化氢所造成的氧化应激损伤有明显的保护作用。     

经导管局部溶栓治疗髂-股静脉血栓:58例回顾性分析

目的　探讨经导管局部溶栓治疗髂 股静脉血栓的效果及临床应用中的有关问题。资料与方法　对 5 8例髂 股静脉血栓形成患者 (病程 <4周 4 5例 ,>4周 13例 ) ,采取经导管血栓局部灌注尿激酶 ,尿激酶先团注2 5 0 0 0 0U ,然后以 12 5 0 0 0～ 15 0 0 0 0U/h持续灌注。结果　全组溶栓治疗时间 4～ 5 6h ,平均 36h ,尿激酶用量75 0 0 0 0～ 72 5 0 0 0 0U ,平均 4 70 0 0 0 0U。阻塞段完全开通 (残存狭窄率 <30 % )者 30例 ,部分开通者 2 3例 ,无效 5例 ,有效率达 91.4 %。对残存狭窄率 >30 %的 2 3例 ,14例行经皮球囊血管成形术 (PTA)治疗 ,9例行PTA及内支架治疗。 6例溶栓前放置下腔静脉过滤器。本组无严重并发症及肺栓塞发生。结论　经导管血栓局部灌注尿激酶是治疗髂 股静脉血栓的安全、有效方法。溶栓术后继续肝素全身抗凝治疗可增强溶栓疗效