经皮椎间孔镜下TESSYS技术治疗腰椎椎间孔狭窄的早期临床疗效观察

目的 探讨经皮椎间孔镜下TESSYS技术治疗腰椎椎间孔狭窄引发腰腿痛的短期疗效.方法 选取2012年3月至2014年9月本院收治腰椎椎间孔处狭窄的患者30例,均选择经皮椎间孔镜下TESSYS技术治疗.术前、术后及末次随访时应用视觉模拟评分(VAS)评估疼痛程度,应用日本骨科协会(JOA)评分评估腰椎功能改善情况.结果 术前及末次随访评分的比较所有患者术中即感觉症状明显缓解.VAS评分由术前(8.13±1.21)分减少至(2.81±1.49)分,JOA评分由术前(10.77±4.21)分升高至(26.30±3.55)分.结论 TESSYS技术治疗腰椎椎间孔处狭窄,有安全性高,具有手术时间短、出血少、并发症少、患者易接受等优点.     

卵圆孔未闭致缺血性卒中临床分析

目的：探讨青年缺血性卒中的可能原因和防治方法。方法分析收集2012年5月至2012年9月4个月间缺血性卒中的临床资料和防治措施。结果卵圆孔未闭（PFO）9例,其中＆lt;45岁的患者7例。结论对45岁以下原因不明的缺血性卒中患者,PFO 是1个独立的危险因素,除常规的同型半胱氨酸、血管炎系列（如抗心磷脂抗体）、血糖、血脂、心电图、TCD、颈部血管超声、心脏彩超、头颈部 CTA、MRA、颅脑 DSA 等,在有条件的医院应行经食道超声检查,提高 PFO 的检出率,行卵圆孔封堵术及早干预,降低卒中的再发风险。     

Mean platelet volume is elevated in patients with patent foramen ovale

Introduction

Platelets play a major role in thromboembolic events. Increased mean platelet volume (MPV) indicates higher platelet reactivity and also a tendency to thrombosis. Patent foramen ovale (PFO), persistence of the fetal anatomic shunt between right and left atria, is strongly associated with cryptogenic stroke. The aim of this study is to determine the relationship between MPV and PFO and if such an association exists, whether higher MPV levels may require antiplatelet therapy before a thromboembolic event happens, together with a literature review.

Material and methods

Thirty patients (15 women, 15 men), free of any cerebrovascular events, were diagnosed with PFO by transesophageal echocardiography (TEE), enrolled as the study group. Thirty consecutive patients (16 women and 14 men), who were diagnosed as normal in TEE, were enrolled as the control group. These two groups were compared according to MPV and anatomical features of the right atrium.

Results

There was no significant difference between study and control groups in clinical features and also no difference was observed in platelet counts; however, MPV in the PFO group was significantly higher than the control group (8.38 ±0.93 fl and 7.45 ±0.68 fl respectively).

Conclusions

Our results indicate that elevated MPV may be detected in patients with PFO. This might be one of the explanations for the relationship between PFO and cryptogenic stroke; however, larger cohorts are warranted in order to define further mechanisms.     

The society for cardiovascular angiography and interventions structural heart disease early career task force survey results: Endorsed by the society for cardiovascular angiography and interventions

Over the last decade, structural heart disease interventions have emerged as a new field in interventional cardiology. Currently, the Accreditation Council for Graduate Medical Education accredited interventional cardiology fellowship programs in the United States provide high‐quality and well established training curriculum in coronary and peripheral interventions, but training in structural interventions remains in its infancy. The current survey seeks to collect relevant information and assess the opinion of interventional cardiology program directors in ACGME‐accredited institutions that are actively involved in structural interventional training. Our study describes the actual number of structural procedures performed by interventional cardiology fellows in ACGME‐accredited programs, the form of the structural training today and the suggestions from program directors who are actively trying to integrate structural training in the interventional cardiology fellowship programs. © 2012 Wiley Periodicals, Inc.     

Surgical closure of patent foramen ovale in patients with suspected paradoxical embolism: long‐term results

Objective—It is thought that a patent foramen ovale (PFO) is the crucial mechanism in patients with suspected paradoxical embolism and cryptogenic stroke. It has been hypothesized that closure of the PFO would prevent further cerebrovascular incidents. We describe our early and late experience with surgical closure of PFO in patients with paradoxical embolism.

Patients and methods—Between May 1994 and December 2001, 33 patients (26 men, 7 women; mean age, 55.2?±?8.7 years; range, 37–74 years) underwent surgical closure of a PFO at our institution. All patients had preoperatively suffered from a stroke and/or a transient ischemic attack, after which echocardiography showed a PFO. Mean follow‐up at 99?±?30 months (range, 10–111 months) was 100% complete.

Results—All patients survived the operative procedure. Early complications occurred in four patients (12%). Actuarial survival at 1, 5 and 8 years was 97?±?3%, 97?±?5% and 94?±?8%, respectively. At long‐term follow‐up all but two patients were alive. The deaths of these two patients were related to malignancy and ischemic heart disease, respectively. Two patients (6%) had suffered a residual cerebrovascular event after successful surgery.

Conclusion—Surgical closure of PFO in patients with paradoxical embolism can safely be performed with a low risk of early mortality. Residual thromboembolic events were rare and in those few it occurred it did so with the interatrial septum being closed, indicating that in those patients the PFO was not the mechanism of the thromboembolic event in the first place.     

枕骨大孔区脑膜瘤的显微手术治疗

目的 总结枕骨大孔区脑膜瘤的手术治疗经验.方法 对2002年1月至2010年4月收治并手术切除的枕骨大孔区脑膜瘤进行回顾性分析.本组共14例,病灶最大径2.5 ～5.0 cm,均经病理证实和显微手术切除.结果 9例采用枕下中线入路,5例采用远外侧入路,全切除12例,次全切除2例;术后早期因呼吸衰竭死亡1例.结论 选择合适的手术入路、采用娴熟的显微外科技术,枕骨大孔区脑膜瘤外科治疗效果良好.