Transcatheter Closure of Atrial Septal Defects by the “Buttoned” Device: Complications and Need for Surgical Revision

Immediate and medium-term experience with transcatheter closure of a secundum atrial septal defect by the ``buttoned' device in seven patients is reported. Complications occurred in two patients during the procedure. In one patient with complications, the occluder was partly released in the right atrium. All efforts to correct its position were unsuccessful and caused considerable deformation of the device, which had to be removed surgically. In the other patient with complications, disconnection of the occluder and counteroccluder occurred immediately after removal of the loading wire. Both parts were retrieved by catheter. Five patients had uneventful closure of the atrial septal defect. On follow-up, however, displacement of the device towards the mitral valve was observed in two patients, which caused mitral regurgitation. Surgical removal of the device and repair of the mitral valve was necessary in both patients. Two years after the procedure, the atrial septal defect was closed completely in two of the remaining three patients and a small residual defect persisted in one patient.     

Direct gamete uterine transfer in patients with tubal absence or occlusion

Purpose: Our aim was to examine the potential of the uterine cavity to affect fertilization and early embryo development. Design: A prospective IRB-approved protocol for patients fulfilling study eligibility criteria was used. Methods: Patients studied included those with primary or secondary infertility, aged less than 38 years, with no history of severe male-factor infertility, and with hysterosalpingogram-and laparoscopic-confirmed bilateral proximal tubal occlusion. Superovulation induction was accomplished with a combination of GnRH agonist and menotropins, with serum hormonal and sonographic monitoring. Within 24 hr prior to, and again at the time of, ovulatory hCG administration, progesterone (P4) was given. Sonographic-guided transvaginal retrieval was performed 35 hr after hCG. Between four and six oocytes were returned to the uterine cavity, admixed with sperm, immediately following retrieval. Luteal support consisted of daily P4 administration. Results: Of the 20 patients recruited for the study, all completed the retrieval and transfer procedure. A total of four clinical pregnancies was achieved, with one early first-trimester loss, one late first-trimester loss (Trisomy 14), and two healthy term infants delivered. IVF of surplus oocytes demonstrated a 82.5% fertilization rate and 66.7% cleavage following cryopreservation. Conclusions: Human fertilization can be achieved through direct uterine transfer of gametes. Furthermore, administration of P4 prior to the ovulatory dose of hCG is compatible with in vitro or in vivo fertilization and implantation.     

氩激光联合中药治疗视网膜静脉阻塞

目的：观察氩激光联合中药治疗视网膜静脉阻塞的疗效。方法：６８例（６８只眼）视网膜静脉阻塞患者采用氩激光治疗，并随机对其中的３２例（３２只眼）联合取用中药，两组患者平均观察１２个月。结果：联合治疗组患者视力增进较激光组的视力更好。结论：氩激光联合中药治疗视网膜静脉阻塞能够更好的提高患眼视力。     

中西医结合治疗慢性周围动脉闭塞性疾病

慢性周围动脉闭塞性疾病（PAO）治疗较为棘手。闭塞的血管不易再通，手术适应症范围小，且术后可能再度发生闭塞[1]。因此寻求适合的保守疗法非常重要。我院自1995年3月至1997年3月治疗PAO患者35例，其中23例用中药溶栓灵配合西药前列素E（PGE1）、天普乐欣（UK）治疗，与单纯用西药治疗的12例比较，疗效尚满意，现报道如下。1临床资料根据中国中西医结合研究会周围血管病专业委员会制定的诊断和分期标准[2]，收治35例PAO患者，包括血栓闭塞性脉管炎（TAO）19例，动脉硬化性闭塞（ASO）16例。随机分为两组：①溶栓灵结合PGEI、UK…     

脑卒中肢体瘫痪的早期康复治疗

目的探讨运动疗法为主的康复治疗对脑卒中恢复期肢体功能恢复的影响。方法采用以运动疗法为主配合中频治疗、作业治疗、电针、心理疏导对94例脑卒中患者瘫痪肢体进行康复治疗。结果94例患者的瘫痪肢体的功能有不程度的恢复，应用Brunnstrom偏瘫肢体功能评定法评定，发病后≤1个月的恢复较理想，与发病后1～3个月和3～6个月的进行肢体功能恢复比较，差异有显著意义（P〈0．01和P〈0．05）。结论早期康复治疗对脑卒中患者肢体功能的恢复效果显著。     

腹针治疗脑血管病后痉挛性瘫痪的疗效观察

目的:探讨治疗脑血管病后痉挛性瘫痪的最佳针刺组穴配方.方法:将60例脑血管病后痉挛性瘫痪的患者按入院先后随机分为腹针组及体针组各30例,均每周治疗5次,连续治疗3周观察疗效.结果:腹针组患者痉挛得到明显改善,相关指标有统计学意义,体针组患者痉挛也有改善,相关指标无统计学意义.两组疗效比较腹针组疗效优于体针组,差异有显著性意义.结论:腹针疗法治疗脑血管病后痉挛性瘫痪是一种安全有效的治疗方法.     

Quantitative assessment of the normal cerebral microvasculature by endothelial barrier antigen (EBA) immunohistochemistry: application to focal cerebral ischemia

Cerebrovascular endothelium participates importantly in the pathophysiology of ischemic injury. Endothelial barrier antigen (EBA) is a protein located in the luminal plasma membrane of normal central and peripheral nervous-system endothelium. In this study, we assessed the sensitivity and specificity of EBA as a quantitative marker of normal endothelium and characterized alterations of EBA immunohistochemistry following focal cerebral ischemia. Anesesthetized, non-ischemic control rats (N=6) were studied. Other animals (N=5) received 90 min of middle cerebral artery occlusion (MCAo) followed by 3-day survival. Brains were prepared by perfusion-fixation and paraffin-embedding. For EBA immunohistochemistry, a monoclonal antibody (1:2000 dilution) was used. Adjacent sections were reacted for activated microglia by isolectin immunochemistry. Morphometric image-analysis was carried out in standardized microscopic fields. In control brains, pial and parenchymal blood vessels of all sizes were distinctly and selectively immunolabeled for EBA; background staining was absent. EBA-positive vascular profiles occupied 4.3+/-0.36% (mean+/-S.D.) of the microscopic field. The mean area of each identified profile was 51+/-13 micromter(2). The low coefficients of variation for both numbers of profiles (17%) and fractional areas (8%) denoted high inter-animal consistency. In brains with prior MCAo, numbers of EBA-immunoreactive vascular profiles in infarcted cortex and striatum were reduced by 39 and 46%, respectively, and their fractional areas were decreased by 63 and 76%, respectively, compared to contralateral hemisphere. Activated microglia were prominent in zones of frank infarction and in adjacent paramedian cortex; the latter region, however, showed normal-appearing EBA-immunostaining. EBA-immunohistochemistry provides a sensitive and specific index of normal cerebrovascular endothelial structures of all sizes. The technique lends itself well to quantitative morphometry and is applicable to perfusion-fixed paraffin-embedded material. EBA immunoreactivity declines in zones of ischemic infarction.     

Postischemic spontaneous hyperthermia and its effects in middle cerebral artery occlusion in the rat

This study examined the time course and effects of postischemic spontaneous hyperthermia after transient and permanent focal ischemia. Rats underwent a 90-min, 120-min, or permanent middle cerebral artery occlusion (MCAO). Body temperatures started rising 15-20 min after MCAO and reached 39-40.5 degrees C during the first hour. Sustained hyperthermia was observed during the rest of the first 24 h. In another experiment, rats were subjected to the same interventions, but a normothermic body temperature was maintained. Spontaneous hyperthermia significantly increased the infarct volumes measured 48 h after MCAO in all groups. Reperfusion 2 h after the onset of ischemia was not beneficial in the hyperthermic animals in contrast to the normothermic group. We also examined the effect of spontaneous hyperthermia on the temporal progression of infarcted and penumbral areas 4, 12, or 48 h after MCAO. During spontaneous hyperthermia, penumbral areas became infarcted areas more rapidly, which was most expressed at 4 h. These findings demonstrate that severe spontaneous hyperthermia can occur in rats after MCAO and that it not only increases the infarct volumes in both transient and permanent ischemia, but also accelerates the incorporation of penumbral areas into necrotic areas, which significantly decreases the window of opportunity for therapeutic interventions.     

A comparison of strain-related susceptibility in two murine recovery models of global cerebral ischemia

Genetically engineered mice are increasingly important in stroke research. The strains on which these constructs are built are known to have inherent differential sensitivities to ischemic insults. This has been largely attributed to differences in vascular anatomy. This study compared the outcome from forebrain ischemia in two common murine background strains using two different types of ischemic insult. C57Bl/6 and SV129 mice were subjected to two vessel (bilateral carotid) occlusion (2VO) or 2VO plus systemic hypotension (2VO+Hypo; mean arterial pressure=30+/-2 mmHg) for 10-20 min. Ventilation and pericranial temperature were controlled. Cerebral blood flow (CBF) was determined by 14C-iodoantipyrine autoradiography. Histologic damage in forebrain structures was measured 3 days post-ischemia. During 2VO+Hypo, the EEG became isoelectric in all animals. During 2VO alone, EEG isoelectricity occurred in 73% of C57Bl/6 and 50% of SV129 mice. Forebrain CBF was reduced to a similar extent in both strains. Greater CBF variability was seen with 2VO alone versus 2VO+Hypo. CBF was less in the 2VO+Hypo model. SV129 mice had wider posterior communicating but smaller basilar artery diameters. With or without hypotension, SV129 mice had markedly less severe histologic damage than C57Bl/6 mice. A time-dependent increase in histologic damage was demonstrated in the 2VO+Hypo model but not with 2VO alone. The 2VO and 2VO+Hypo models produced similar magnitudes of histologic injury in C57Bl/6 mice subjected to 10-min ischemia. SV129 mice were resistant to ischemia in either model. The 2VO+Hypo model produced a more uniform severity of ischemia as defined by CBF and EEG examination. Despite this, the murine strain had a substantially greater impact on histologic outcome than did cerebrovascular anatomy or the type of model used to produce the ischemic insult.     

不同参数激光诱导脉络膜视网膜静脉吻合

目的　探讨不同激光参数、不同击射部位对脉络膜 视网膜静脉吻合形成的影响。方法　在视网膜分支静脉阻塞模型上 ,以不同参数在不同部位诱导吻合支的形成 ,以荧光素眼底血管造影、连续组织切片观察吻合支的建立及其周围组织反应情况。结果　功率 90 0、12 0 0、15 0 0、180 0mW诱导吻合支的成功率为 0、2 0 .83%、4 5 .83%、6 2 .5 0 % (P=0 .0 0 1) ;直径 5 0、10 0 μm诱导吻合支的成功率分别为 4 3.75 %、2 0 .83% (P =0 .0 16 ) ;击射部位距视盘边缘 2DD与 3DD对吻合支形成的影响无统计学意义 (P =0 .732 ) ,2DD与4DD间 (P =0 .0 2 8) ,3DD与 4DD间 (P =0 .0 2 3)差异均有显著性 ;12 0 0、15 0 0mW诱导的吻合支周围组织损伤较轻 ,180 0mW诱导的吻合支周围组织损伤较重。结论　功率、光斑直径是影响脉络膜 视网膜静脉吻合形成的 2个主要因素 ,其中功率起决定性作用 ;5 32nm激光诱导吻合支形成的最适功率和直径为 12 0 0～ 15 0 0mW、5 0 μm ;击射部位以距视盘 3DD处最佳