Intracardiac Eustachian Valve Cyst in an Adult Detected with Other Cardiac Anomalies: Usefulness of Multidetector CT in Diagnosis

We present an unusual case of an intracardiac Eustachian valve cyst observed concurrently with atresia of the coronary sinus ostium, a persistent left superior vena cava (LSVC) and a bicuspid aortic valve. There have been several echocardiographic reports of Eustachian valve cysts; however, there is no report of multidetector computed tomography (MDCT) findings related to a Eustachian valve cyst. Recently, we observed a Eustachian valve cyst diagnosed on MDCT showing a hypodense cyst at the characteristic location of the Eustachian valve (the junction of the right atrium and inferior vena cava). MDCT also demonstrated additional cardiovascular anomalies including atresia of the coronary sinus ostium and a persistent LSVC and bicuspid aortic valve.     

Anomalous left anterior descending artery from pulmonary artery: An extremely rare coronary anomaly

We report a rare coronary artery anomaly–anomalous origin of the left anterior descending artery from the pulmonary artery in a 40-year-old woman. The uniqueness of this case is the absence of any significant morbidity from this condition in adulthood which is in contrast to other reported cases where patients present with myocardial infarction, congestive heart failure, and sometimes death during the early infantile period.¹     

A gastric duplication cyst with an aberrant pancreatic ductal system: report of a case

We report an extremely rare case of a gastric duplication cyst together with an aberrant pancreatic ductal system, which communicated with the stomach rather than the pancreatic ductal system with no evidence of pancreatitis. A 46-year-old woman developed severe abdominal pain after a 10-year history of occasional mild abdominal pain. Upper gastrointestinal barium radiography showed a rigidity of the stomach wall, and gastroscopy revealed a fistula orifice at a greater curvature of the gastric body. Subsequent endoscopic suction of mucous secretion from within the fistula provided immediate pain relief. Abdominal computed tomography and ultrasonography showed a cystic mass contiguous with the stomach wall. Surgical exploration revealed an uncommon anomaly of a gastric duplication cyst with the aberrant pancreatic lobe. The patient made an uneventful recovery and remains well 4 years after surgery. We also herein review ten other similar cases of this uncommon congenital anomaly reported in the literature. Received: August 20, 2001 / Accepted: January 8, 2002     

加与不加人工瓣环Danielson成形术矫治Ebstein畸形的比较

目的 比较应用Danielson成形术与Danielson加人工瓣环矫治Ebstein心脏畸形的效果,以确定后者在治疗Ebstein心脏畸形中的作用.方法 2006年1月1日至2009年12月31日,31例10岁以上的青少年及成年A或B型Ebstein心脏畸形患者中19例采用单纯Danielson成形术矫治(A组),12例采用Danielson成形术加人工瓣环矫治(B组),回顾分析两组临床资料及治疗效果.结果 围术期A组死亡1例(1/19例),B组无死亡,组间差异无统计学意义(P=0.510).所有术后生存患者随访5～41个月,平均(23.0±18.5)个月.A组术后1年1例因中重度三尖瓣关闭不全再次行三尖瓣成形术后死亡;B组术后无晚期死亡,组间远期病死率差异无统计学意义(P =0.724).超声复查显示患者房化心室均消失;三尖瓣反流结果,A组轻度11例,中到重度7例,B组轻度2例,无中到重度,组间差异显著(P=0.026).心功能NYHA A组Ⅰ级11例,Ⅱ～Ⅲ级7例;B组均为Ⅰ级,P=0.024.随访期内B组的6 min步行距离(6MWD)显著优于A组[(415±41)m对(382±46)m,P=0.047].结论 Danielson成形术加用人工瓣环矫治有助于提高A或B型Ebstein心脏畸形患者的中、远期疗效.     

成人间活体右半肝移植术中变异门静脉右支切取与重建技术

目的 探讨成人间活体右半肝移植术中变异门静脉支(APVB)切取与重建的技巧.方法 2002年1月至2007年4月,共实施70例成人间活体右半肝移植.术前肝脏血管三维CT成像显示供肝动脉及静脉走向,70例右半供肝中有9例门静脉分支变异,其中7例为Ⅱ型变异,2例为Ⅲ型变异.除1例供者行狭窄桥状连接单口切取APVB外,其余8例均采用供者优先的原则即距门静脉主干2～3mm处双口切断APVB.Ⅱ型变异中有2例双口切取其右前、右后支成形为一个开口后与受者门静脉主干吻合,4例右前、右后支分别与受者门静脉左、右支吻合,1例行右前、右后支间狭窄桥状组织连接单口切取后与受者门静脉主干单口吻合.Ⅲ型变异中有1例双口切取其右前、右后支分别与受者门静脉支双口吻合,1例双口切取后行新型的U形血管移植物间置与受者门静脉主干单口吻合.结果 9例受者均无门静脉狭窄或血栓、肝动脉狭窄或血栓以及肝静脉流出道狭窄等血管并发症发生.1例供者术后3 d并发门静脉血栓,手术取栓及门静脉壁修补成形后痊愈.新型的U形血管移植物间置重建术后通畅,无并发症发生.结论 成人间活体右半肝移植术中采用供者优先的原则双口切取APVB、双口吻合重建以及新型的U形血管间置等门静脉重建技术是安全可行的,未增加手术难度,且临床效果良好.     

先天性脊柱侧凸患者脊椎畸形及椎管内畸形的特点

目的:探讨先天性脊柱侧凸(CS)患者脊椎畸形与椎管内畸形的特点及两者间的关系.方法:对我院2005年9月～2007年5月收治的123例CS患者的影像学资料进行回顾性分析.统计不同类型脊椎畸形及不同类型椎管内畸形的特点,分析两者之间的关系.结果:123例患者的脊椎畸形中,28例(22.8%)为形成障碍(FF).43例(35.0%)为分节障碍(SF),52例(42.2%)为混合型障碍(MT).28例FF均在胸腰椎,其中前方结构畸形(AM)19例(67.9%),前后方结构畸形(APM)9例(32.1%);单节段畸形(SM)19例(67.9%),多节段畸形(MM)9例(32.1%).43例SF中,AM 9例(20.9%),后方结构畸形(PM)3例(7.0%),APM 31例(72.1%);SM 9例(20.9%),MM 34例(79.1%);214个节段受累,胸椎196个.52例MT中,AM 6例(11.5%),APM 46例(78.5%);SM 6例(11.5%),MM 46例(78.5%).37例(31.7%)患者有椎管内畸形,其中脊髓纵裂14例,低位脊髓2例,脊髓纵裂合并低位脊髓21例.35例脊髓纵裂患者中34例位于胸椎、腰椎或跨越胸腰椎,33例为SF或MT:23例低位脊髓中21例发生于SF或MT.结论:FF好发于胸椎和腰椎,多为单纯AM,SF和MT好发于胸椎,多为APM.脊椎畸形好发于胸椎,脊髓纵裂好发于胸椎和腰椎,脊髓纵裂和低位脊髓好发于SF或MT.     

A rare anomaly of the anterior communicating artery complex hidden by a large broad-neck aneurysm and disclosed by three-dimensional rotational angiography

Double fenestration of the anterior communicating artery (ACoA) complex associated with an aneurysm is a very rare finding and is usually caused by ACoA duplication and the presence of a median artery of the corpus callosum (MACC). We present a patient in whom double fenestration was not associated with ACoA duplication or even with MACC, representing therefore, a previously unreported anatomic variation. A 43 year old woman experienced sudden headache and the CT scans showed subarachnoid haemorrhage (SAH). On admission, her clinical condition was consistent with Hunt and Hess grade II. Conventional digital subtraction angiography (DSA) was performed and revealed multiple intracranial aneurysms arising from both middle cerebral arteries (MCA) and from the ACoA. Three-dimensional rotational angiography (3D-RA) disclosed a double fenestration of the ACoA complex which was missed by DSA. The patient underwent a classic pterional approach in order to achieve occlusion of both left MCA and ACoA aneurysms by surgical clipping. The post-operative period was uneventful. A rare anatomical variation characterised by a double fenestration not associated with ACoA duplication or MACC is described. The DSA images missed the double fenestration which was disclosed by 3D-RA, indicating the importance of 3D-RA in the diagnosis and surgical planning of intracranial aneurysms.     

Developmental venous anomaly, cavernous malformation, and capillary telangiectasia: spectrum of a single disease

Summary Developmental venous anomalies (DVAs), cavernous malformations, and capillary telangiectasias are related vascular malformations of the central nervous system. Mixed lesions of the central nervous system vasculature have been reported in a host of combinations, including many possible concomitant combinations of cavernous malformations, venous anomalies, capillary telangiectasias, and arteriovenous malformations (AVMs). We describe the natural history of disease in a female with developmental venous anomaly, cavernous malformation, and capillary telangiectasias appearing in sequence. Correspondence: Robert F. Spetzler MD, C/o Neuroscience Publications, Barrow Neurological Institute, 350 W. Thomas Rd., Phoenix, 85013 AZ, USA.     

先天性脐尿管异常疾病的诊治体会（附9例报告）

目的：探讨先天性脐尿管异常疾病的诊断与治疗方法。方法：根据病史并结合脐孔或膀胱美蓝注射试验、膀胱镜检查、瘘管造影、B超、CT等辅助检查方法诊断脐尿管异常疾病9例,并进行相应手术治疗。结果：手术及病理检查证实脐尿管瘘并感染3例,脐尿管囊肿并感染3例,脐尿管窦道并感染1例,膀胱顶部憩室1例,确诊后自动出院1例。患者术后排尿正常,8－18天痊愈出院,随访至今无复发及癌变。结论：脐孔或膀胱美蓝注射试验、膀胱镜检查、瘘管造影、B超、CT等辅助检查为有效的诊断措施;手术范围应以尽可能彻底切除脐尿管及其异常组织为宜。     

腹腔镜治疗妇科急症593例临床分析

目的:探讨腹腔镜治疗妇科急症的可行性、安全性及治疗效果。方法:回顾分析2003年7月至2007年10月我院用腹腔镜治疗593例妇科急症患者的临床资料。结果:593例患者均用腹腔镜完成手术,其中异位妊娠512例,手术时间18～75min,平均32min,术中出血10～70ml,平均25ml;盆腔炎、盆腔脓肿47例,手术时间35～90min,平均49min,术中出血45～130ml,平均84ml;黄体破裂、卵巢内膜囊肿破裂、卵巢囊肿蒂扭转34例,手术时间35～80min,平均52min,术中出血20～85ml,平均65ml;术后住院3～7d,平均4.5d,随访12～36个月无复发。结论:腹腔镜手术治疗妇科急症安全可行,且具有良好的效果。