MR T2加权成像显示胆囊壁增厚点状高信号的意义

目的研究病理组织学证实的胆囊腺肌瘤病、慢性胆囊炎和管壁增厚型胆囊腺癌在MRL加权成像（T2WI）显示病变胆囊壁点状高信号的特征。方法38例患者（胆囊腺肌瘤病16例，慢性胆囊炎13例，管壁增厚型胆囊腺癌9例），每例均进行了MR常规T1WI、常规T2WI和3mm薄层T2WI及MR胰胆管成像（MRCP）。所有患者均接受了胆囊切除手术。2名高年资放射科医生共同分析不同序列MRI，观察胆囊壁增厚及T2WI显示病变胆囊壁点状高信号的不同表现，将观察结果与病理组织学检查所见对照。结果所有患者的胆囊壁均明显增厚，厚度范围5～15mm，平均9mm。T2WI显示病变胆囊壁存在各种各样的点状高信号，在胆囊腺肌瘤病，点状高信号分布于整个增厚的胆囊壁，且数量较多（5～15个／cm^2），较大（直径2～7mm），边界清楚，呈现中等至明显高信号；在慢性胆囊炎，点状高信号主要位于增厚胆囊壁的黏膜侧，数量较少（3～5个／cm^2），较小（直径2～4mm），边界清楚，呈中等至明显高信号；在管壁增厚型胆囊腺癌，点状高信号边界欠清，呈现稍高信号，其数量和大小差异较大，分布范围取决于癌组织浸润胆囊壁的深度。结论胆囊腺肌瘤病、慢性胆囊炎和管壁增厚型胆囊腺癌在T2WI呈现的点状高信号有一定差别，正确识别这些点状高信号的特征有助于鉴别诊断良恶性胆囊壁增厚。     

Does monthly native arteriovenous fistula blood-flow surveillance detect significant stenosis--a randomized controlled trial.

BACKGROUND: Clinical practice guidelines recommend that the preferred method of surveillance for arteriovenous fistula (AVF) is the measurement of AVF blood flow (Qa). As these recommendations are based on observational studies, we conducted a randomized, prospective, double-blind, controlled trial to assess whether Qa surveillance results in an increased detection of AVF stenosis. METHODS: A total of 137 patients were randomly assigned to receive either continuing AVF surveillance using current clinical criteria (control, usual treatment) or usual treatment plus AVF blood-flow surveillance by ultrasound dilution (Qa surveillance group). The primary outcome measure was the detection of a significant (>50%) AVF stenosis. RESULTS: There were 67 and 68 patients assigned to the control and Qa surveillance groups, respectively. Patients in the Qa surveillance group were twice as likely to have a stenosis detected compared with the control hazard ratio (HR) confidence interval (CI) group (2.27, 95% 0.85-5.98, P = 0.09), with a trend for a significant stenosis to be detected earlier in the Qa surveillance group (P = 0.09, log rank test). However, using the Qa results alone prior to angiography, the area under the receiver operating characteristic curve demonstrated, at best, a moderate prediction of (>50%) AVF stenosis (0.78, 95% CI 0.63-0.94, P = 0.006). CONCLUSION: This study demonstrates that the addition of AVF Qa monitoring to clinical screening for AVF stenosis resulted in a non-significant doubling in the detection of angiographically significant AVF stenosis. Further, large multi-centre randomized trials are feasible and will be necessary to confirm whether Qa surveillance and the correction of detected AVF stenosis will lead to a reduction in AVF thrombosis and increased AVF survival.     

Functional mechanism underlying cyclooxygenase-2 expression in rat small intestine following administration of indomethacin: Relation to intestinal hypermotility

Background and Aim:  We recently reported that cyclooxygenase (COX)-2 is upregulated in the rat small intestine after administration of indomethacin, and this may be the key to non-steroidal anti-inflammatory drug (NSAID)-induced intestinal damage. The present study investigated the mechanism for COX-2 expression induced in the rat small intestine by indomethacin, in relation with ulcerogenic processes.
Methods:  Animals were given indomethacin or SC-560 p.o., and the intestinal mucosa was examined 24 h later.
Results:  Indomethacin caused hemorrhagic lesions in the small intestine, accompanied with an increase in intestinal motility, bacterial invasion and inducible nitric oxide synthase (iNOS) activity, as well as the expression of COX-2 mRNA in the mucosa. Although SC-560 did not cause any damage, this agent caused intestinal hypermotility, the bacterial invasion and the upregulation of COX-2 expression. The mucosal PGE₂ content was decreased by SC-560 at 3 h but recovered 12 h later, and this recovery of PGE₂ was attenuated by both atropine and ampicillin, in addition to rofecoxib. The intestinal hypermotility response to indomethacin was prevented by both 16,16-dimethyl PGE₂ and atropine, but not ampicillin. Yet all these agents inhibited not only the bacterial invasion but also the expression of COX-2 and iNOS activity in the intestinal mucosa following indomethacin treatment, resulting in the prevention of intestinal lesions.
Conclusion:  These results suggest that COX-2 expression in the intestinal mucosa following the administration of indomethacin is associated with intestinal hypermotility and bacterial invasion. The intestinal hypermotility caused by COX-1 inhibition may be a key to COX-2 expression after administration of NSAIDs and their intestinal ulcerogenic properties.     

妇产科手术后粘连性肠梗阻的治疗

目的:探讨妇产科手术后粘连性肠梗阻的治疗 .方法:分析30例妇产科手术后粘连性肠梗阻的临床特点和治疗.结果:保守治疗成功16例(53.3%),保守无效而中转手术14例(46.7%),9例行肠切除术.结论:妇产科手术后粘连性肠梗阻易发生肠绞窄,临床表现不典型,应采取积极的手术疗法.     

Co-localization of vasoactive intestinal polypeptide, γ-aminobutyric acid and choline acetyltransferase in neocortical interneurons of the adult rat

Interneurons immunoreactive for vasoactive intestinal polypeptide (VIP) are integral elements of columnar organization patterns in the rat cerebral cortex. By application of the sensitive mirror technique, the co-localization of VIP with the classical inhibitory neurotransmitter γ-aminobutyric acid (GABA) and the acetylcholine-synthesizing enzyme, choline acetyltransferase (ChAT), was investigated in neocortical neurons. Furthermore, the frequency of co-localization of ChAT with GABA was determined. In a sample of 118 VIP-immunoreactive neurons, mostly from the primary somatosensory cortex, it was demonstrated that virtually all of them reveal immunoreactivity for GABA and, therefore, are to be GABAergic. Moreover, 34% of mostly bipolar, VIP-positive neurons contained ChAT and are, thus, supposedly cholinergic as well. Co-localization of VIP and ChAT varied according to cortical laminae. Finally, 88% of a total of 60 ChAT-immunoreactive neurons were also immunostained for GABA. It is concluded that almost all VIP-immunoreactive neurons and most of the cholinergic neurons in rat neocortex represent partly overlapping subpopulations of inhibitory interneurons utilizing GABA.     

Dural arteriovenous malformations at the base of the anterior cranial fossa: report of nine cases

Nine men with dural arteriovenous malformations (DAVM) at the base of the anterior cranial fossa are described. Four patients had intracerebral haemorrhage and four had seizures, associated with haemorrhage in two. In three cases the fistula was an incidental finding. In five cases the diagnosis could be made before angiography, on the basis of CT findings. Angiographically, venous drainage was always seen into ascending cortical veins. Five cases demonstrated drainage via the olfactory vein into the basal vein of Rosenthal; in four this way was the principal route of drainage. Five patients underwent surgery, the therapy of choice. One fistula closed spontaneously after angiography. Two patients refused treatment and one was not treated because of his poor general condition. Because arterial supply was usually bilateral, from small branches of the ophthalmic artery, embolisation seemed to be more dangerous. Compared to dural fistulae in other locations the DAVM of the anterior cranial fossa have a higher risk of complications and should be treated even if asymptomatic at the time of diagnosis.     

Outpatient laparoscopic cholecystectomy: a reality.

BACKGROUND: The author reports on his personal experience with outpatient laparoscopic cholecystectomy (LC), focusing on the main guidelines for preoperative and postoperative care and operating technique. METHODS: From January 1, 2000 to December 31, 2000, 71 laparoscopic cholecystectomies were performed on outpatients. The patients remained in the outpatient surgery center for 36 hours. In 4 cases, the operation was converted into laparotomy. Twenty patients remained in the hospital and were discharged 5 to 7 days later. Twelve were rehospitalized due to pathologies that could not be treated at home. RESULTS: In all 71 cases, a complete remission of the symptoms occurred, and none of the patients died either during the operation or during the postoperative period. Eighty percent of patients were treated in outpatient surgery centers. CONCLUSIONS: With clear guidelines, LC is a major surgical operation that can be performed in outpatient surgery centers without death or other major complications and with very good remission of symptoms.     

硬脑膜动静脉瘘65例

目的：对硬脑膜动静脉瘘临床诊断治疗特点进行探讨。方法：对60例患者行血管内栓塞治疗，5例行颈动脉压迫法治疗。其中13例1次栓塞，25 例行2次栓塞，17例行3次栓塞，5例行4次或多次栓塞，结果：治愈36例，好转25例，4例无效，无一例死亡，结论：硬脑膜动静脉瘘的临床表现和预后与其发病部位，静脉引流类型密切相关，颈动脉压迫法及选择性血管内栓塞是安全有效的治疗方法。     

Ventricular septal fistula formation due to infectious endocarditis in a hemodialysis patient with aortic valve replacement

We report a case of infectious endocarditis in a 77-year-old woman who was undergoing maintenance hemodialysis therapy, and who was also having a prosthetic aortic valve replacement. The disease resulted from a local skin infection at the needle puncture site of the arteriovenous fistula. Ampicillin-resistant Staphylococcus aureus was the causal organism. Surgical treatment could not be performed because of associated intracranial hemorrhage due to septic embolism. In spite of intensive treatment with several antibiotics, a ventricular septal abscess just beneath the prosthetic aortic valve progressed to form a ventricular septal fistula. The resultant intracardiac left-to-right shunt led to refractory congestive heart failure. The patient finally died of heart failure. The formation of a ventricular septal fistula is considered to be a rare and extraordinary complication of infectious endocarditis in a hemodialysis patient with aortic valve replacement. Received: July 25, 2001 / Accepted: November 3, 2001     

An Unusual Complication of Vesical Stones

The author reports a complicated recurrence of genital tract fistula. The initial vesicovaginal fistula resulted from obstructed labor, which was subsequently surgically managed without success. The patient had a recurrent vesicovaginal fistula that was formed by the erosion of vesical stones through the anterior endopelvic fascia into the vagina. The stones eventually eroded into the rectum, resulting in the formation of a complex vesicovaginal and rectovaginal fistula.