Patent Foramen Ovale Not So Patent

Transesophageal echocardiography (TEE) with agitated saline contrast is the most sensitive tool for diagnosing patent foramen ovale (PFO), but false positives can result. We report a patient who underwent a TEE during the study of a cryptogenic stroke. Contrast appeared in the left atrium with the Valsalva maneuver. However, the contrast exit site was not identified, and contrast continued to appear with Valsalva once the saline microbubbles had disappeared. Combined with the contrast characteristics, this suggested a spontaneous contrast phenomenon rather than a PFO. This phenomenon must be kept in mind to avoid overdiagnosing PFO .     

CT立体定向辅助射频热凝治疗三叉神经痛

目的分析CT立体定向技术在治疗三叉神经痛中的辅助作用.方法通过CT扫描确定卵圆孔位置,采用立体定向技术穿刺卵圆孔,射频热凝术治疗三叉神经痛,并与徒手穿刺组进行对比.结果立体定向组一次穿刺成功率和治疗优良率为100%,并发症出现率为3.8%,徒手穿刺组一次穿刺成功率83.3%,治疗优良率93.3%,并发症为16.7%.结论CT立体定向技术为定位穿刺靶点提供了客观依据,避免了穿刺的盲目性,提高了穿刺的准确性和治疗效果,降低了并发症的发生率.     

腰椎间孔神经阻滞配合椎间孔外口针刀松解治疗腰椎间盘突出症的临床观察

目的观察腰椎间孔神经阻滞配合椎间孔外口针刀松解治疗腰椎间盘突出症的临床效果。方法将确诊为腰椎间盘突出症的患者200例随机分为观察组和对照组,观察组行腰椎间孔神经阻滞并椎间孔外口针刀松解,对照组行单纯腰椎间孔神经阻滞治疗,观察治疗后1个月、3个月、6个月的疗效,两组并进行比较。结果1个月后随访观察组优良率（92.2%,95/103例）明显高于对照组（81.4%,79/97例）（P〈0.05）;3个月和6个月后随访观察组优良率（92.2%,94/102例;90.2%,92/102例）也明显高于对照组（78.4%,76/97例;76.3%,74/ 97例）（P〈0.01）。结论腰椎间孔神经阻滞配合椎间孔外口松解,较单纯腰椎间孔神经阻滞治疗腰椎间盘突出症,可明显提高疗效,其远期效果尤为明显。     

国人卵圆孔穿刺深度X线解剖测量的研究

目的 :为探讨国人卵圆孔穿刺深度提供X线解剖依据。方法 :35例颅骨 (70侧 )标本 ,将卵圆孔涂钡后 ,摄取球管向头侧倾斜 2 0°角度的头颅侧位片 ,测量卵圆孔与内耳门中心点到前床突尖端连线 (耳—床线 )之间的距离 (孔—线距 ) ,进行统计学处理。结果 :左右各组孔—线距值均不能拒绝总体为正态的假设 (P >0 0 5 ) ;左右两侧之间孔—线距值有差别 ,具有统计学意义 (P <0 0 5 )。左侧孔—线距参考值为 (14 .71± 1.4 6 )mm ,右侧为 (15 .5 7± 1.80 )mm。结论 :在X线图像上以耳—床线为基线、孔线距参考值为标准 ,可间接测算卵圆孔的位置 ,推算卵圆孔穿刺时穿刺针进针的深度。     

Sonographic imaging of foramen ovale electrodes.

OBJECTIVE: In patients with medically intractable partial epilepsy of mesiotemporal origin, video electroencephalographic monitoring with foramen ovale electrodes is necessary to plan neurosurgical interventions. Imaging of these electrodes after implantation hitherto required conventional radiography, magnetic resonance imaging, or computed tomography of the skull. These methods are expensive. Therefore, the aim of our work was to show the capability of more cost-effective transcranial B-mode sonography for visualization of the electrodes. METHODS: In this pilot study, a 42-year-old female patient with implanted foramen ovale electrodes was examined transtemporally with a 2-MHz sector transducer to visualize the intracranially implanted electroencephalographic recording device. RESULTS: Foramen ovale electrodes could be detected easily in the patient, and bedside monitoring of explantation was possible. CONCLUSIONS: We were able to show the applicability of transcranial B-mode sonography for visualization of foramen ovale electrodes in preoperative electroencephalographic monitoring of patients with epilepsy. Further evaluation of this method in additional patients will follow.     

颅底卵圆孔的观测

本文就广东出土的颅骨108个,计216侧卵孔的形态,位置和位置关系以及与三叉神经节穿刺有关的距离进行观测,见到卵圆孔呈卵圆形者占大多数(93.98±1.62%)。从卵圆孔外侧缘中点到颞下颌关节结节前根外侧缘的距离36.41±1.94mm、至颧下嵴切迹的距离47.98±3.07mm其两侧相互关系相对稳定,差异甚小。     

The use of a bedside assay for plasma B-type natriuretic peptide as a biomarker in the management of patent ductus arteriosus in premature neonates

OBJECTIVE: To test the utility of the bedside plasma concentration of B-type natriuretic peptide (BNP) assay as a screen for patent ductus arteriosus (PDA) in premature neonates. STUDY DESIGN: Newborn infants admitted to the neonatal intensive care unit (NICU) had paired echocardiography and BNP measurements at enrollment and every 4 to 5 days. RESULTS: Twenty neonates (gestational age approximately 28.6 weeks and birth weight approximately 1161 g) had 81 paired echocardiography and BNP determinations. BNP ranged from 5 to 3900 pg/mL. Fifty-six of 81 echocardiograms showed PDA. Significant correlations were found between BNP and ductal size and degree of shunting. Correlation was greater in infants >2 days of age. BNP >300 pg/mL predicted significant PDA, whereas BNP <105 pg/mL predicted absence of significant PDA. CONCLUSION: Bedside measurement of BNP correlates with magnitude of PDA in premature newborns, particularly beyond day 2, and may be useful in guiding diagnostic and management strategies.     

Physiology of the fetal circulation

Our understanding of fetal circulatory physiology is based on experimental animal data, and this continues to be an important source of new insight into developmental mechanisms. A growing number of human studies have investigated the human physiology, with results that are similar but not identical to those from animal studies. It is time to appreciate these differences and base more of our clinical approach on human physiology. Accordingly, the present review focuses on distributional patterns and adaptational mechanisms that were mainly discovered by human studies. These include cardiac output, pulmonary and placental circulation, fetal brain and liver, venous return to the heart, and the fetal shunts (ductus venosus, foramen ovale and ductus arteriosus). Placental compromise induces a set of adaptational and compensational mechanisms reflecting the plasticity of the developing circulation, with both short- and long-term implications. Some of these aspects have become part of the clinical physiology of today with consequences for surveillance and treatment.     

Characteristics of the interatrial communication in patients undergoing transcatheter device closure of atrial septal defects for cryptogenic stroke

Background: Prior studies suggest that patent foramen ovale (PFO) diameter >4 mm is associated with a high probability of cryptogenic ischemic stroke (CIS). Methods: We evaluated all patients diagnosed with CIS who underwent closure of intra-atrial communication (IAC) using the Amplatzer atrial septal defect (ASD) occluder in our institution between August 1997 and March 2004. For each IAC, echocardiographic diameters and balloon-stretched diameters were recorded. Stretchability index was calculated as the ratio of stretched diameter to unstretched diameter. Results: Fifty-six patients met the inclusion criteria for this study. There was an inverse logarithmic relationship between unstretched IAC diameter and stretchability index. For the 28 smaller defects, the median IAC diameter was 2 mm, and median stretchability index was 5.58 (range 2.6–15). For the 28 larger defects, median diameter was 6 mm, and median stretchability index was 2.38 (range 1.05–5). The difference in stretchability index between the two groups was significant ( P < 0.0001). Conclusion: Our data bring into question the concept that the diameter of the defect would singularly predict the probability of stroke.     

Intracardiac thrombosis in multiple chambers and descending aorta manifested as systemic and pulmonary thromboembolism

We report a case with multiple thrombosis that underwent sudden circulatory collapse due to acute pulmonary embolism and ischemic stroke. Further confirmed by transesophageal echocardiography, the thrombus in both atria was detected by transthoracic echocardiography. In addition, patent foramen ovale and another thrombus in the descending aorta were readily identified by transesophageal echocardiography. Aspirin was prescribed and thrombi disappeared 1 month later. Our case report suggests that patients undergoing sudden collapse with unexplained hypoxemia and new neurological deficit secondary to coexistence of pulmonary and systemic embolism should be promptly evaluated by echocardiography, especially transesophageal one, with high suspicion for paradoxical embolism.