伴有颅内血肿的前循环破裂出血动脉瘤超早期显微手术治疗

目的 探讨伴有颅内血肿的前循环破裂出血动脉瘤超早期显微手术治疗.方法 27例前循环动脉瘤破裂伴颅内血肿形成患者24 h内行显微手术治疗,探讨其影像学特点、手术方法.结果 27例术中诊断与术前一致,责任动脉瘤为前交通动脉瘤6例,后交通动脉瘤8例,大脑中动脉瘤13例.多发动脉瘤3例,2例位于同侧前循环,1次手术夹闭,1例另1枚动脉瘤位于对侧大脑中动脉分叉处,择期手术处理.出血动脉瘤均为中小型动脉瘤.术后GOS分级Ⅴ级14例,Ⅳ级9例,Ⅲ级2例,Ⅰ级2例.结论 前循环动脉瘤破裂伴颅内血肿形成超早期显微手术清除血肿,夹闭动脉瘤,效果满意.

Abstract：

Objective To explore ultra - early microsurgical management in patients with ruptured aneurysms of anterior circlulation combined with intracerebral hematoma. Method The imaging characteristics and operation methods of 27 cases of ruptured aneurysms of anterior circlulation combined with intracerebral hematoma underwent surgery within 24 hours were collected. Results The surgical outcomes indicated that the intraoperative diagnoses were consistent with preoperative diagnoses in all cases. The rupture aneurysms include 6 cases of anterior communicating artery aneurysms,8 posterior communicating artery aneurysms,and 13 middle cerebral artery aneurysms. There were 3 patients harbored two aneurysms,2 in homolateral anterior circulation clipped at the same time, 1 in contralateral middle artery clipped in another operation. The aneurysms were all middle or small size. The postoperative Glasgow Outcome Scales (GOS) were grade Ⅴ in 14 patients,grade Ⅳ in 9, grade Ⅲ in 2, grade Ⅰ in 2. Conclusions For patients with ruptured aneurysms of anterior circlulation combined with intracerebral hematoma, favorable outcome chould be achieved through ultra - early microsurgical management     

帆状胎盘前置血管破裂出血1例

患者女,25岁,以停经16周突发阴道流血1h就诊。患者G1P0,无腹痛,血红蛋白12g/L;超声检查共3次。使用仪器分别为:HITACHI525、LOGIQBOOK及西门子OMNIA彩色超声诊断仪。第1次检查结果:①单活胎;②前壁胎盘,胎盘位置偏低;③子宫左后方囊性肿物。23h后因怀疑低置胎盘且血红蛋白降为9g/L。复查超声见:前壁胎盘,厚3.0cm,胎盘实质回声不均,胎盘下缘部分遮盖宫颈内口。胎盘中段内可见6.0cm×3.1cm不规则无回声区。超声诊断:①单活胎;②胎盘实质回声不均———胎盘早剥不除外。3h后因疑胎盘早剥第3次复查:宫内见一胎儿,胎心搏动规律,心率15…     

异位妊娠破裂致内出血患者围术期的护理探讨

目的：研究探讨异住妊娠破裂并失血性休克患者围术期的抢救和护理。方法：以我院收治的76例异位妊娠患者（其中破裂合并失血性休克患者11例）的临床资料为研究对象,并做回顾性分析。结果：76例均治愈出院,随访76例,效果良好。结论：异位妊娠破裂并失血性休克的患者,起病急且迅速加重,常危及生命。准确诊断,从速手术,精心护理是提高抢救成功率的关键。     

血管内介入栓塞治疗老年颅内前循环破裂动脉瘤疗效及血清中MMP-9和Caspase-3水平变化

目的 探究血管内介入栓塞治疗老年颅内前循环破裂动脉瘤疗效及血清中MMP-9、Caspase-3水平变化.方法 选取本院接收的老年颅内前循环破裂动脉瘤患者81例,根据治疗方法不同分为开颅手术组和血管内介入栓塞组,另取老年健康人群20例作为健康对照组.比较开颅手术组和血管内介入栓塞组治疗前后的格拉斯哥意识障碍评分系统(Glasgow Coma Scale,GCS)、格拉斯哥预后评分系统(Glasgow Outcome Scale,GOS)、住院时间和并发症发生率,比较健康对照组以及开颅手术组和血管内介入栓塞组治疗前后血清中含半胱氨酸的天冬氨酸蛋白水解酶3(Cysteine-containing aspartate-specific proteases 3,Caspase-3)和质金属蛋白酶-9(Matrix Metalloproteinase-9,MMP-9)水平.结果 血管内介入栓塞组和开颅手术组术后的GCS评分、GOS评分、Caspase-3、MMP-9均显著大于术前,且血管内介入栓塞组术后均显著高于开颅手术组术后(均P＜ 0.05);血管内介入栓塞组住院时间和并发症发生率均显著低于开颅手术组(均P＜ 0.05).结论 血管内介入栓塞组治疗老年颅内前循环破裂动脉瘤具有更佳的有效性和安全性.     

改良Paine点脑室穿刺术在颅内前循环破裂动脉瘤急性期夹闭术中的应用

目的 探讨改良Paine点脑室穿刺术在颅内前循环破裂动脉瘤急性期夹闭术中的应用效果。方法 回顾性分析2019年1月至2020年8月夹闭术治疗的28例颅内前循环破裂动脉瘤的临床资料;术中均采用改良Paine点脑室穿刺术。结果 28例发病至手术时间2~70 h,平均38.5 h;穿刺成功27例,失败1例（脑室受压后狭小）。28例均无因穿刺诱发的颅内出血、颅内感染及脑脊液漏,术后发生言语障碍1例、脑梗死2例、肺部感染3例、癫痫发作1例、肢体活动障碍2例、下肢深静脉血栓形成1例。出院时GOS评分4~5分26例,3分2例。4例出院前因病情较重而无法完成CTA检查;其余24例CTA检查显示,23例动脉瘤瘤颈夹闭完全,1例显示夹闭不全。术后随访3个月~1年,22例CTA或DSA复查显示瘤颈夹闭完全、动脉瘤未显影。结论 颅内前循环破裂动脉瘤急性期,采用夹闭术治疗,术中改良Paine点穿刺术可有效、迅速释放脑脊液,降低颅内压,有助于动脉瘤的显露,提高夹闭术效果,减少并发症。     

The Hospital for the Ruptured and Crippled Eugene H. Pool, Fourth Surgeon-in-Chief 1933–1935 Followed by Philip D. Wilson, Fifth Surgeon-in-Chief 1935

In 1933, for the second time in the history of the Hospital for the Ruptured and Crippled (R & C), a general surgeon, Eugene Hillhouse Pool, MD, was appointed Surgeon-in-Chief by the Board of Managers of the New York Society for the Relief of the Ruptured and Crippled. R & C (whose name was changed to the Hospital for Special Surgery in 1940), then the oldest orthopaedic hospital in the country, was losing ground as the leading orthopaedic center in the nation. The R & C Board charged Dr. Pool with the task of recruiting the nation's best orthopaedic surgeon to become the next Surgeon-in-Chief. Phillip D. Wilson, MD, from the Massachusetts General Hospital in Boston and the Harvard Medical School was selected and agreed to accept this challenge. He joined the staff of the Hospital for the Ruptured and Crippled in the spring of 1934 as Director of Surgery and replaced Dr. Pool as Surgeon-in-Chief the next year. It was the time of the Great Depression, which added a heavy financial toll to the daily operations of the hospital. With a clear and courageous vision, Dr. Wilson reorganized the hospital, its staff responsibilities, professional education and care of patients. He established orthopaedic fellowships to support young orthopaedic surgeons interested in conducting research and assisted them with the initiation of their new practices. Recognizing that the treatment of crippling conditions and hernia were becoming separate specialties, one of his first decisions was to restructure the Hernia Department to become the General Surgery Department. His World War I experiences in Europe helped develop his expertise in the fields of fractures, war trauma and amputations, providing a broad foundation in musculoskeletal diseases that was to be beneficial to him in his future role as the leader of R & C.     

Duration of ruptured membranes and extended labor are risk factors for HIV transmission.

OBJECTIVES: To determine the effects of duration of ruptured membranes (DRM) and duration of labor in HIV transmission. METHODS: A retrospective cohort study of 366 HIV-infected pregnant women and their infants analyzed the effects of these two variables; the cut-off point for transmission increase was estimated using a ROC curve. A multivariate analysis was performed with the most important risk factors according to the literature: maternal age, lymphocyte count, use of invasive procedures during gestation, antiretroviral treatment during pregnancy and labor, mode of delivery, newborn weight, DRM, labor duration, and the interaction of these last two factors. RESULTS: The cut-off points were estimated at 6 h for DRM and at 5 h for labor duration. A lymphocyte count below 500 cells/ml, use of invasive procedures, use of antiretroviral treatment during pregnancy and interaction between DRM, and labor duration remained significant in perinatal HIV transmission (P<0.05). CONCLUSIONS: An increased DRM increased perinatal HIV transmission when it was associated with prolonged labor.     

Hunt-Hess高分级破裂脑动脉瘤的急性期手术治疗

目的 探讨Hunt-Hess高分级破裂脑动脉瘤的急性期手术治疗效果。方法 对1995年1月－2000年12月间29例Hunt-Hess高分级破裂动脉瘤患的急性期手术治疗情况手术效果进行回顾性分析。其中Ⅳ级27例，Ⅴ级2例。结果 随访2个月－4年，本组患生存率为83％；恢复良好7例，皆为HuntⅣ级病例，占24％；HuntⅤ级病例无一例恢复良好，预后不佳。结论 对Hunt Ⅳ级破裂动脉瘤应提倡急性期手术，而对于Ⅴ级患应避免急性期手术。     

Survival after transarterial embolization for spontaneous ruptured hepatocellular carcinoma

Objectives  To examine the survival of patients with spontaneous ruptured hepatocellular carcinoma treated with transarterial embolization (TAE). Methods and materials  Patients diagnosed with spontaneous ruptured hepatocellular carcinoma treated with TAE were retrospectively studied. Hospital records were reviewed and data were collected and analyzed from the years 2000–2006. A total of 62 patients who had been diagnosed with spontaneous ruptured hepatocellular carcinoma were managed in our hospital during this period. Results  All 62 patients (who had been diagnosed with ruptured hepatocellular carcinoma and were managed in our hospital) patients were treated with TAE, with a success rate of 91% (57/62). Early mortality (within 30 days after rupture) was 38%. Factors that were associated with early mortality were old age, low hemoglobin at presentation, elevated bilirubin at presentation, prolonged prothrombin time at presentation (INR > 1.3), low albumin level at presentation, and unsuccessful embolization. A low albumin level was the only independent risk factor for early mortality. The overall median survival time was 39 days. Surgical resections were possible in seven patients. Their cumulative survival was significantly longer (P = 0.002) than that of patients managed with non-operative treatment after embolization. Conclusion  Transarterial embolization (TAE) can achieve good hemostasis, though low albumin level, which reflects poor liver reserve, may predict early mortality. Portal vein thrombosis should not be regarded as an absolute contraindication for TAE. Staged surgical resection after embolization is safe and produces a good survival outcome.     

Isolated non-obstructive accessory mitral valve tissue in an adult mimicking ruptured chordae

Accessory mitral valve tissue is commonly associated with other congenital heart diseases and is usually detected in children causing left ventricular outflow tract obstruction. We present an adult patient with isolated non-obstructive accessory mitral valve tissue that was mimicking ruptured chordae of the mitral valve. Accessory mitral valve tissue in adults is very rare and can mimick various causes of left ventricular outflow tract obstruction. This patient represents the first case in literature wherein an unobstructive accessory mitral valve tissue simulated a ruptured chordae. This case illustrates that in patients with suspected mitral valve chordae rupture without any mitral regurgitation, this diagnosis should be considered, which can have therapeutic implications.