Delayed manifestation of aortic stenosis after blunt abdominal trauma: Report of a case

Delayed manifestation of aortic stenosis caused by abdominal blunt trauma is rare. We report herein the case of a 67-year-old man who was taken to a nearby hospital after being crushed between a heavy truck and a wall. An emergency laparotomy was performed, revealing only a mesenteric tear which was repaired. He was discharged after an uneventful postoperative course; however, 1 month later he began to experience intermittent claudication, and presented to our hospital in December 1994, 1 year after the first operation. Angiography and enhanced computed tomography (CT) demonstrated infrarenal abdominal aortic dilatation with distal stenosis. Both the dilated and stenotic lesions were resected and bypass surgery was performed. Pathologic examination demonstrated that the intima had been lacerated circumferentially and everted distally, causing the aortic stenosis. To our knowledge, this is the first case of the delayed manifestation of traumatic aortic stenosis to be documented in Japan. The etiology of this rare complication of blunt trauma is described in this report.     

腹腔镜与开腹幽门环肌切开术的前瞻性比较研究

目的研究比较腹腔镜幽门环肌切开术（LP）和开腹幽门环肌切开术（OP）治疗先天性幽门肥厚性狭窄的疗效及免疫功能的变化。方法自2003年4月-2006年7月将72例先天性幽门肥厚性狭窄患儿随机分成二组（LP组及OP组各36例），比较二组麻醉时间、手术时间、术后进食时间及术后并发症，监测二组术前、术后第一天、术后第三天的外周血T淋巴细胞亚群、C反应蛋白（CRP）及白细胞介素-6（IL-6）和肿瘤坏死因子（TNF）的变化并行对比研究。结果二组麻醉时间、手术时间、术后进食时间差异无统计学意义，OP组术后并发症要略多于LP组，比较二组术前、术后第一天、术后第三天的外周血T淋巴细胞亚群、CRP及IL-6和TNF的变化差异无统计学意义。结论腹腔镜幽门环肌切开术（LP）和开腹幽门环肌切开术（OP）治疗先天性幽门肥厚性狭窄的临床效果相近，二组患儿免疫功能的变化无显著性差异。腹腔镜幽门环肌切开术是一种稳定、可靠的手术，对于治疗先天性肥厚性幽门狭窄的效果满意。     

Percutaneous angioplasty of carotid artery stenoses

Summary Percutaneous angioplasty is a well-established method of treating arterial stenoses and occlusions in various regions. In the carotid area this technique is still under discussion. The successful application of angioplasty in eight patients with carotid artery stenoses is reported.Adapted from a paper presented at XII European Congress for Neuroradiology in Prague, 27–29 September, 1984     

Techniques for high-resolution MR imaging of atherosclerotic plaque

Atherosclerotic cardiovascular disease is the most common cause of death in the United States. Investigation of atherosclerotic plaque morphology and composition is important because the findings may be useful in predicting prognosis or response to therapy. This study presents high-resolution magnetic resonance (MR) imaging techniques developed on a 1.5-T whole-body imager with a custom-built surface coil, for characterizing the composition and morphology of plaque removed at carotid endarterectomy. The initial comparison of MR imaging and histologic results showed good correlation. In conjunction with MR angiography, these techniques could be used in in vivo imaging to define the size, location, and contents of atherosclerotic plaque at the carotid bifurcation.     

Laryngotracheal stenosis: a serious complication of percutaneous tracheostomy

Tracheostomy in patients requiring prolonged artificial ventilation in intensive care is increasingly being performed by a percutaneous dilatational technique, in preference to the standard surgical method. Since its introduction numerous series have reported favourably on its general safety in the short-term, but there have been few reports of longer term follow-up of patients. We present four cases of laryngotracheal stenosis, a previously unreported complication associated with the technique, and discuss the relevance of these to the future practice of percutaneous tracheostomy.     

Ross procedure in an infant weighing 4.5 kg

A 6 month-old male infant (weight: 4.5 kg) with congenital aortic stenosis underwent aortic valve replacement with a pulmonary autograft (Ross procedure). The right ventricular outflow tract (RVOT) was reconstructed with a polytetrafluoroethylene (PTFE)-valved equine pericardial conduit. At the age of 5, re-RVOT reconstruction with an equine pericardial patch bearing a PTFE monocusp was required because of severe pulmonary stenosis resistant to 2 attempts of percutaneous transluminal pulmonary valvotomy. Currently, at the age of 8, the degree of aortic regurgitation is trivial and the pulmonary autograft is free of functional deterioration despite somatic growth.     

风湿性二尖瓣狭窄心肌病理改变与心肌运动的关系

目的 :探讨风湿性二尖瓣狭窄 (Mitralstenosis ,MS)患者心肌病理改变与心肌运动的关系 .方法 :MS患者 2 2例术前行常规心脏超声及组织多普勒成像 (Dopplertissueimag ing,DTI)检查 ,于心尖四腔切面记录室间隔侧二尖瓣环长轴方向射血期频谱S波和舒张期频谱D波峰值及心电图R波至频谱S波起始点的时间T ,选取 3个波幅最大的心动周期 ,算出此 3个心动周期的平均值S3 、D3 和T3 ;二尖瓣置换术中切取左室乳头肌行病理检查 .结果 :微动脉Di/Do与D3 呈正相关 ,(r =0 .5 0 ,P <0 .0 5 ) ;心肌纤维化程度与T3 呈正相关 ,(r=0 .6 8,P <0 .0 5 ) ;而S3 与D3 呈正相关 ,(r =0 .4 3,P <0 .0 5 ) .结论 :术前DTI检查测量D3 及T3 ,可以反映心肌病理变化 ,有助于对MS患者手术适应证的掌握及对预后的判断     

彩色多普勒超声图指导风湿性心脏病二尖瓣狭窄球囊扩张术91例

目的：应用彩色多普勒超声心动图指导经皮二尖瓣球囊成形术(PBMV)治疗风湿性二尖瓣狭窄的价值、方法：运用彩超对行PBMV的患进行术前术后检查，观察二尖瓣钙化程度及部位、开口形状、瓣口面积、二尖瓣返流(MR)程度、瓣下病变、左房左室大小、左房有无血栓．结果：91例PBMV术后患中，术后MR72例，其中MR新出现19例，MR加重8例、与术前对比，术后二尖瓣开放幅度、二尖瓣口面积、二尖瓣跨瓣压、二尖瓣压差半降时间较术前有明显改善趋势，左房内径、肺动脉内径较术前有缩小趋势．同时，术后左房压、右室压及肺动脉压也有下降趋势。结论：彩超能明确PBMV治疗二尖瓣狭窄的效果。影响：PBMV效果的因素较多，但二尖瓣钙化的程度、部位和瓣膜形态较为重要。     

金属支架治疗大气道狭窄

目的　探讨气管支架成形术缓解大气道狭窄的方法、安全性和疗效。资料与方法　气管狭窄患者 32例 ,其中气管切开或插管后局部组织过度增生 7例 ,转移性肿瘤压迫气管 12例 ,多发性软骨炎引起气管塌陷 1例 ,肺癌 12例 ;单纯气管狭窄 2 8例 ,主支气管狭窄 1例 ,气管支气管同时有狭窄者 3例。术前均经CT检查及气管体层片证实气管、支气管狭窄。 13例术前用的卡因喷喉麻醉 ,19例在全身麻醉下置入支架。结果　 32例共放置 37枚气管支架 ,均一次置入成功 ,无操作失败 ,通气全部得到改善 ,手术成功率 10 0 %。 2例气管狭窄经置入支架后复发狭窄再次置入支架。 33枚置于气管 ,4枚置于主支气管。 1例狭窄严重仅容 4F导管通过 ,用球囊导管扩张至 12mm后置入支架 ;其余均直接置入支架。术后通气功能明显改善 ,无需吸氧 ,无明显胸痛、咯血等并发症。 1周后X线复查无支架移位 ,可见支架进一步扩张。 1例甲状腺癌支架置入术后 2周复发呼吸困难 ,CT扫描示支架内有新生物 ,经支架内放射治疗后症状消失。结论　气管内支架成形术方法简单、安全 ,缓解呼吸困难疗效迅速、确实 ,适合良恶性气道狭窄姑息治疗     

介入治疗移植肾动脉狭窄的疗效观察

目的　评价介入治疗移植肾动脉狭窄 (TRAS)的疗效。资料与方法　 2 0 0 0年 1月～ 2 0 0 2年 11月 ,采用经皮血管内成形术 (PTA)和 /或内支架治疗 2 0例TRAS患者 ,其中PTA治疗 14例次 ,内支架治疗 9例次。对治疗前后的血压、降压药物和血肌酐进行随访。结果　采用PTA治疗者 ,收缩压、舒张压、降压药物和血肌酐由术前的(15 7± 17)mmHg、(97± 7)mmHg、(1.5± 1.0 )种、(5 12± 2 96 ) μmol/L ,术后 1周降为 (137± 11)mmHg(P <0 .0 5 )、(86± 7)mmHg(P <0 .0 1)、(0 .9± 1.0 )种 (P >0 .0 5 )、(2 76± 2 2 6 ) μmol/L(P <0 .0 5 ) ,术后 6个月降为 (12 8±10 )mmHg(P <0 .0 1)、(83± 7)mmHg(P <0 .0 1)、(0 .8± 0 .9)种 (P >0 .0 5 )、(14 5± 5 5 ) μmol/L(P <0 .0 1)。采用内支架治疗者 ,收缩压、舒张压、降压药物和血肌酐由术前的 (15 4± 31)mmHg、(93± 12 )mmHg、(1.6± 1.0 )种、(338±14 2 ) μmol/L ,术后 1周降为 (134± 17)mmHg(P >0 .0 5 )、(82± 7)mmHg(P <0 .0 5 )、(0 .8± 1.0 )种 (P >0 .0 5 )、(197±76 ) μmol/L(P <0 .0 5 ) ,术后 6个月为 (132± 9)mmHg(P >0 .0 5 )、(83± 4 )mmHg(P <0 .0 5 )、(0 .5± 0 .8)种 (P >0 .0 5 )、(2 0 4± 16 9) μmol/L(P <0 .0 5 )。总