Streamlined flow in the portal vein: demonstration with MR angiography

PURPOSE: To demonstrate whether streamlining of the portal vein flow exists by evaluating the relative distribution of blood flowing from the superior mesenteric vein (SMV) and splenic vein (SV) into the portal venous system. MATERIALS AND METHODS: Fifteen healthy adult volunteers underwent MR angiography of the main portal vein (PV) and portal vein branches after an overnight fast. Transverse two dimension time-of-flight gradient echo sequences were obtained three times, in suspended expiration and inspiration, respectively, as follows: 1) No presaturation slab, 2) presaturation slab across the SMV, 3) presaturation slab across the SV. Signal intensity (SI) measurements were obtained for all acquisitions. using regions of interest traced manually within the PV and portal branches. RESULTS: After presaturation of the SMV and SV during expiration, the overall SI average in the PV decreased by 47% +/- 8 (mean +/- SD) and 17% +/- 9, respectively. Right to left portal branch SI ratio and right-anterior to left-posterior SI ratio in the PV were 0.91 +/- 0.09 and 1.02 +/- 0.08 at baseline, respectively. They decreased significantly (P < 0.05) to 0.87 +/- 0.09 and to 0.95 +/- 0.09 after saturation of the SMV, and increased significantly to 0.95 +/- 0.08 and to 1.07 +/- 0.10 after saturation of the SV. CONCLUSION: MR angiography with selective saturation of the SMV and SV provided reproducible assessment of the respective contributions of the SMV and SV to portal flow, and allows demonstration that streamlining of splanchnic blood occurs in the portal vein of normal subjects.     

Portomesenteric vein gas: diagnostic and prognostic value

Portomesenteric pneumatosis has been traditionally associated with intestinal infarction and poor outcome; however, recent studies have questioned its clinical value. To assess its diagnostic and prognostic significance we have retrospectively evaluated 47 patients correlating the CT finding of portomesenteric vein gas with clinical data and outcome. Thirty-nine patients (83%) had surgical evidence of intestinal infarction, four had necrotic small bowel volvulus (8.5%), two had blunt trauma, one had necrotic gastric volvulus, and one a gastric mucosal lesion induced by a nasogastric tube. Fifteen patients survived (31.9%); only 8/39 patients with intestinal infarction survived. Portomesenteric pneumatosis is a reliable marker of intestinal infarction and poor outcome; however, in trauma patients this sign is associated with a better prognosis. Electronic Publication     

Hepatic portal venous gas as a complication of diverticulitis with a colovenous fistula: a case report

We report here a case of sigmoid diverticulitis complicated by a colovenous fistula, as a rare but also a nonfatal cause of hepatic portal venous gas. The different radiological examinations and their features will be discussed. Electronic Publication     

建立下肢骨折术后并发深静脉栓塞预警机制的可行性研究

目的探讨建立对下肢深静脉栓塞疾病发生的预警机制。方法对既往无血栓形成病史的下肢骨折及骨病住院病人(合并其它部位骨折者也纳入统计组)共44例,根据下肢深静脉栓塞危险度(Wells评分表)的评分和进行的实验室指标监测,分析这些指标对下肢深静脉栓塞形成的临床意义和诊断价值,对得出的统计学资料进行多重线性回归分析。结果下肢骨折患者术后根据危险度的评分定为高危组患者相应的血栓前状态实验室指标(D二聚体、纤维蛋白原、vWF)均呈阳性,且实验室指标(D二聚体,纤维蛋白原)的数值与Wells评分呈正相关(可建立回归方程),予超声多普勒监测可进一步证实诊断。结论骨科患者术后处于下肢深静脉栓塞的血栓前状态(PTS),故建立深静脉血栓形成的预警机制是必要的和可行的。     

山羊肺静脉心肌袖解剖学观测

目的观察山羊肺静脉心肌袖的形态特征,为异位房颤动物模型提供依据。方法对30例山羊肺静脉,充分暴露心肌袖,进行形态学观测。结果30例羊心均出现肺静脉心肌袖,其中斜形47.6%,环形40.9%,纵形11.5%。右上、右下、左下、左上肌袖厚度分别为0.46±0.14 mm、0.35±0.16 mm、0.35±0.11 mm、0.37±0.13 mm;长度分别为10.75±3.15 mm、9.46±2.20 mm、11.41±2.87 mm、9.20±2.88 mm。结论山羊肺静脉心肌袖出现率为100%,4支肺静脉中以右上肺静脉直径最大。     

活体碘油门静脉灌注大鼠肝泡球蚴感染模型的观察研究

目的:观察活体碘油灌注在大鼠肝泡球蚴感染模型中的分布,探讨肝泡状棘球蚴病的血供.方法:20只感染肝泡球蚴病大鼠经门静脉灌注碘油,分别在不同时间处死动物,取新鲜肝脏行钼靶摄影后进行HE及苏丹Ⅳ染色,观察碘油分布.结果:活体条件下对感染肝泡球蚴的大鼠经门静脉灌注碘油可选择性地进入病灶周围,苏丹Ⅳ染色于病灶周围的炎症反应带中可见碘油沉积.结论:门静脉参与肝泡状棘球蚴病的部分供血,为经门静脉介入治疗提供了可靠的理论依据.     

应用重组内皮抑素腺相关病毒抑制内皮细胞趋化运动

【目的】检测重组内皮抑素腺相关病毒(rAAV-Endostatin)感染膀胱癌细胞后内皮抑素的分泌及其对内皮细胞趋化运动的抑制作用,为rAAV-Endostatin抑制膀胱癌血管生成基因治疗提供依据。【方法】以rAAV-Endostatin感染膀胱癌EJ细胞,24 h后ELISA法测定上清液中内皮抑素浓度;以该上清液为条件介质,Tran-swell法检测其对血管内皮细胞趋化运动的抑制作用。【结果】rAAV-Endostatin转染EJ细胞后上清液中内皮抑素浓度为54.09 ng/ml,经Transwell检验,该上清液对血管内皮细胞趋化运动的抑制率为37.45%。【结论】rAAV-Endostatin是介导内皮抑素基因治疗的有效载体,为膀胱癌的原位基因治疗奠定了基础。     

银杏叶与血栓通治疗视网膜静脉阻塞的成本-效果分析

目的:研究银杏叶与血栓通治疗视网膜静脉阻塞的经济学效果。方法:采用成本-效果分析法,以74例(75只眼)患者为对象,对银杏叶与血栓通治疗视网膜静脉阻塞进行经济学评价。结果:2组总有效率分别为89·74%、88·89%;成本分别为2776·48、2413·60元;成本-效果比分别为30·94、27·15。结论:血栓通治疗视网膜静脉阻塞更为经济。     

肝硬化患者门脉系统血流动力学变化与肝脏储备功能的相关性研究

目的 探讨肝硬化患者门脉系统血流动力学变化及其与肝脏储备功能Child—Pugh分级的相关性。方法 应用彩色多普勒超声（彩超）检测173例肝炎后肝硬化患者（Child A级61例，B级53例，C级59例）门静脉内径（DPv）、门静脉平均血流速度（Vpv）、门静脉血流量（Qpv）、脾静脉内径（Dsv）、脾静脉平均血流速度（Vsv）、脾静脉血流量（Qsv），并与正常人进行对比研究。结果 肝硬化患者DPv、Dsv增宽，VPvVsv减慢，Qsv增加，肝功能损害越严重，变化越明显；QPv在Child A级、B级患者增加，Child C级患者减少。结论 肝硬化患者肝功能损害程度不同，门脉系统血流动力学变化程度不同；彩超测量肝硬化门脉血流动力学变化对了解病情严重程度及预后判断有重要意义。     

去炎松玻璃体内注射治疗视网膜中央静脉阻塞引起的黄斑水肿37例

目的:评估去炎松玻璃体内注射治疗视网膜中央静脉阻塞造成的黄斑水肿效果。方法:中央视网膜静脉阻塞(CRVO)并发黄斑水肿患者37例(37眼)接受玻璃体腔注射去炎松(40g/L,0.1mL,1～3次)治疗。非缺血性CRVO33眼,缺血性CRVO4眼,注射1次20眼,注射2次15眼,注射3次2眼,平均随访时间9(3～27)mo。患者从症状出现至一次注射药物平均时隔时间为2.7(0.3～9)mo。注射前后均进行最佳矫正视力、眼压、裂隙灯显微镜、荧光素眼底血管造影(FFA)和中央黄斑厚度光相干断层扫描(OCT)检查。结果:治疗前平均视力为0.08(0.01～0.4)。注射后1～3mo,最佳矫正视力提高25眼,无变化3眼,视力下降9眼,在视力提高患眼中,视力提高3行以上12眼,视力提高2行10眼,提高1行3眼。此后,部分视力下降和视力未提高患者,进行2次或3次注射,最终随诊时视力提高24眼,视力无变化3眼,视力下降10眼,在视力提高的患眼中,视力提高3行以上8眼,视力提高2行10眼,提高1行6眼,整个治疗前后平均视力增加2～3行。治疗后1～3mo时,间接眼底镜检查黄斑水肿完全消退16眼,水肿明显减轻19眼,水肿加重2眼。最终随诊时,间接眼底镜检查黄斑水肿完全消退19眼,减轻17眼,加重1眼。15眼在注射药物后1wk～6mo期间先后出现不同程度的高眼压达35.4(25.1～40.1)mmHg(1mmHg=0.133kPa),13眼进行降眼压治疗,其中4眼接受抗青光眼手术。在32只晶状体眼中,出现了晶状体后囊膜下混浊的并发性白内障9眼,进行白内障摘除4眼。OCT检查发现玻璃体腔注射药物治疗后黄斑厚度减少,中央黄斑平均厚度减少至注射前厚度的46%。4眼没有视力的提高。结论:玻璃体腔内注射去炎松是一种治疗视网膜中央静脉阻塞引起黄斑水肿的有效方法。对于缺血性中央视网膜静脉阻塞患者视力不会提高。