Value of Doppler ultrasound for the diagnosis of renal artery stenosis in children

To evaluate the reliability of Doppler ultrasonography (US) in identifying children with renal artery stenosis (RAS) among those with hypertension, we compared Doppler US results in 22 hypertensive children (mean age 8.9±4.3 years), with (13 cases) and without RAS at angiography, and in 33 normotensive children (mean age 8.8±4.7 years). We observed 2 false-negatives and 2 false-positives with Doppler US. Of the 2 false-negative diagnoses, 1 had RAS on an accessory renal artery located behind a normal upper polar artery and the other was observed in a patient with bilateral multiple stenosis of the very distal segments of renal arteries. The 2 false-positive diagnoses were due to sinuous left renal artery and to technical reasons, respectively. In another patient, Doppler US showed a tight RAS, while arteriography was normal. RAS was subsequently confirmed by a second arteriography. Peak systolic velocity values of Doppler US were significantly higher in patients with proven angiographic RAS (3.44±0.66 m/s) than in hypertensive patients with normal renal arteries at angiography (0.99±0.35 m/s, P <0.0001) and normotensive healthy children (1.04±0.23 m/s, P <0.0001). With the use of multiple views, and the experience acquired with practice, false-negatives or false-positives due to the geometry of the renal artery can be avoided. Nevertheless, very distal stenosis can be missed by Doppler US. Received October 30, 1995; received in revised form April 16, 1996; accepted May 14, 1996     

Non-invasive variant of Gorlin formula can be used to identify severe aortic stenosis

Summary. In recent years the continuity equation has been established as a valuable non-invasive method for calculating aortic valve area. The continuity equation cannot be used if there is calcification or sub-valvular stenosis in the left ventricle-outflow tract, because the area of the outflow trace is not circular in those cases. The authors have tested the value of a non-invasive variant of the Gorlin formula, as an alternative method of identifying severe aortic stenosis. They examined 32 consecutive patients with aortic stenosis with both methods. Seventeen patients had severe stenosis (valve area^0–7 cm²), calculated by the continuity equation. The other 15 patients had moderate stenosis (valve area 0–7–1–0 cm²). Using the non-invasive variant of the Gorlin formula, the authors were able to identify 16 of the 17 cases with severe stenosis, thus showing that the method is useful for identifying severe aortic stenosis. (P<0–001 by x²-test).     

氟骨症性椎管狭窄症的手术治疗

１９８７～１９９０年手术治疗氟骨症性椎管狭窄症１００例。包括颈椎９例，胸椎８例，腰、骶椎８３例。术后随访１～４年，复查结果：临床治愈９３例（９３％）：显效３例（３％）、有效３例（３％）、无效１例（１％）。手术原则是彻底减压，因氟骨症具有椎骨及其骨周组织严重退变、异化和骨化的临床病理特点，故在胸、腰椎减压术后，一般不影响其稳定性，在颈椎施行双开式或单开式椎管扩大加植骨融合术，则可收减压、稳定及防止或减少椎板间隙瘢痕狭窄的效果。     

椎板后移回植的椎管扩大术治疗椎管狭窄症

作者报告棘突劈开、椎板后移回植的椎管扩大术治疗椎管狭窄症１８２例，使椎管容积扩大３４．８％，横径扩大３．８ｍｍ，矢径扩大６．１ｍｍ。随访２年９个月，优良率８６．６％，椎板愈合率９６．９％。本文探讨少数椎板迟延愈合的原因和预防措施，如斜切椎板、缝合固定和腰背筋膜与棘上韧带悬吊缝合等。术后卧床１０～１２周，用石膏型保护。作者认为本法能有效的预防术后脊柱不稳，顽固性腰痛等并发症。     

腰椎间盘突出合并椎管狭窄的手术治疗

报告手术治疗腰椎间盘突出症合并退行性腰椎管狭窄症１０４例。术后随访９０例，随诊时６个月～６年。优良率８６．５％，无腰椎不稳和腰椎滑脱等并发症。为获得优良效果，作者强调在处理椎间盘突出的同时必须彻底解除侧隐窝及神经根管，黄韧带肥厚对神经根的压迫，才能彻底根除症状     

输尿管镜治疗输尿管结石185例

目的探讨输尿管镜气压弹道碎石治疗输尿管结石的效果。方法2004年2月～2005年3月，我们对185例输尿管结石（其中伴肾绞痛96例）采用输尿管镜取石或气压弹道碎石进行总结和分析。结果失败12例，其中6例改开放手术，6例术后3d行体外冲击波碎石。一次碎石成功率93．5％（173／185），其中上段结石为75．0％（24／32），中段为95．8％（46／48），下段为98．1％（103／105）。肾绞痛者成功率为100％（96／96）。术中输尿管损伤率2．9％（5／173），其中3例（1．7％）中转开放手术。术后肾绞痛1例。全组随访6～12个月，平均10．2月，无复发。结论输尿管镜气压弹道碎石安全有效，并发症少，是治疗输尿管中下段结石的首选方法，尤其对肾绞痛者疗效更好。     

代谢综合征患者肾动脉狭窄的SCTA与DSA对比研究

目的探讨代谢综合征(MS)患者中肾动脉狭窄的发生率及无创性筛检的必要性与可靠性。方法45例MS患者预行肾动脉螺旋CT血管造影(SCTA),对所检出的14例肾动脉狭窄者行肾动脉数字减影血管造影(DSA)对照,并对SCTA及DSA结果进行对比分析。结果45例MS患者中SCTA显示肾动脉正常31例,其余14例患者存在单侧或双侧肾动脉狭窄,DSA对照显示肾动脉正常6条,肾动脉狭窄22条,与SCTA显示的情况基本符合。结论MS患者中肾动脉狭窄的发生率约31.1%,对可疑患者应常规予以肾动脉SCTA检查。     

腰椎管狭窄症的手术减压与内固定选择(259例临床分析)

目的：探讨腰椎管狭窄症的手术减压指征、减压范围及内固定选择。方法：回顾性分析腰椎管狭窄症患者259例，平均年龄52．2岁，平均病程4年1个月。根据病情分别采用椎板间节段开窗潜行减压术139例，腰椎管内径扩大成形术63例，全椎板切除减压、椎间植骨融合内固定术57例。结果：221例获得平均4年2个月随访。三种手术方法优良率分别为91．53％、87．50％和85．45％；手术并发症发生率为13．69％、15．87％和20．11％。结论：对严重的腰椎管狭窄症若手术适应证和减压范围掌握恰当，不论采取何种手术方式的神经减压术，均可取得满意疗效。正确选择病例和熟练的外科技术是应用内固定器械的重要条件。     

开放手术观察腰椎间盘突出症溶核失败45例分析

目的 通过开放手术观察分析椎间盘髓核化学溶解术治疗腰椎间盘突出症失败原因。方法 收集溶核失败的腰椎间盘突出症45例行开放手术治疗。结果 术中见45例硬膜外脂肪完全消失，43例髓核未见溶解，2例髓核溶解呈糊状但未被吸收，21例伴有侧隐窝狭窄，15例突出物与神经根粘连，20例黄韧带增厚，2例椎管骨性狭窄，14例突出物钙化。结论 腰椎间盘突出症病变间隙合并有侧隐窝狭窄、神经根粘连、椎管狭窄、突出物钙化等，不是溶核治疗的适应证。