Fertility and pregnancy outcomes following hypogastric artery ligation for severe post-partum haemorrhage

BACKGROUND: Hypogastric artery ligation is a therapeutic option for severe post-partum haemorrhage. Little is known about the outcomes of subsequent fertility and pregnancy. We studied these parameters in women who required hypogastric artery ligation for severe post-partum haemorrhage in our institution over a 13-year period. METHODS: All patients who required hypogastric artery ligation for severe intractable post-partum haemorrhage from January, 1989 to April, 2001 were included. Data were retrieved from medical files and telephone interviews. RESULTS: A total of 68 patients required hypogastric artery ligation during the study period. Seventeen patients had 21 pregnancies with 13 term deliveries, two ectopic pregnancies, three miscarriages, and three abortions. Twenty-eight patients did not want a new pregnancy and one patient refused the interview. Twenty-three (34%) patients were lost to follow up. None of the patients suffered subsequent infertility and pregnancy was achieved in <12 months once planned. Pregnancy outcomes were normal. Fifty-four percent had vaginal deliveries. Three patients suffered a threatened post-partum haemorrhage that was easily treated medically. CONCLUSIONS: This is the largest reported series of pregnancies following hypogastric artery ligation. Hypogastric artery ligation for post-partum bleeding >1 l appears to be a safe procedure that does not impair subsequent fertility and pregnancy outcomes.     

Sarcoma of the pulmonary artery: report of four cases with electron microscopic and immunohistochemical examinations,and review of the literature

Herein we report the clinicopathological features of four cases of pulmonary artery sarcoma that appeared at our institution during a period of 30 years. The patients, 2 males and 2 females, were 50–62 years old. Tumour was found in the pulmonary trunk and right pulmonary artery in all cases, in the pulmonary valve and left pulmonary artery in three of the four cases, and in the right ventricular outflow tract in one case. There was direct extension or metastases to the lungs in two cases, the heart in one case, mediastinum or lymph nodes in two cases and the pleura in one case. Ultrastructural examination in one case revealed cells with features of smooth muscle cells and myofibroblasts. Immunohistochemical examination of three cases gave the following results: vimentin and smooth muscle specific actin was positive in all three cases, desmin in one case and cytokeratin in one case. No positivity was found for Factor VIII. This and other studies indicate that histologically most pulmonary artery sarcomas are leiomyosarcomas or undifferentiated spindle cell sarcomas. Immunohistochemical and ultrastructural examinations favour an origin from myofibroblasts, probably derived from multipotent (undifferentiated) cells in the wall of the vessel. Most lesions show extensive intrathoracic growth although they rarely metastasize outside the thoracic cavity. They have a poor prognosis although some cases are currently being diagnosed during life.     

胸腰段后髓动脉的起源及其临床意义

目的:为选择性脊髓血管造影和椎管内显微外科提供解剖学资料。方法:采用尸体标本30例,于节段性动脉内逐一注入红色乳胶,在完整脊髓上解剖观察。结果:每例脊髓胸腰段的后髓动脉数目5～13支,平均8.4支。后髓动脉起始情况分3型10亚型,其中后髓动脉与前髓动脉由同一肋间后动脉发出仅34支(13.5％)。胸下部及腰部后髓动脉呈典型“发卡”样折曲。后髓动脉平均外径0.37±0.12mm。约1/3标本在T_(11)～L_3间有1支后髓动脉较粗(>0.5mm),它是脊髓后下部血供的主要来源。结论:多数后髓动脉单独起始,较大的后髓动脉应引起注意。     

腰动脉的应用解剖

观察了20具(40例)成人尸体的腰动脉,阐明了腰动脉的数目、起源、走行、口径、长度、起始平面与腹主动脉的夹角及相邻两腰动脉间的距离。为临床上由腰动脉插管进行的选择性脊髓造影术提供了解剖学依据。     

周围神经干自然分束部位血管形态及临床意义

应用微血管灌注透明法观察研究5具成人周围神经干标本.重点观察神经自然分束部位微血管形态和分支分布规律.神经干内有非常完兽的血供系统.手术中循神经自然分束进行追踪分离,不会对神经血供产生明显影响.但在张力下牵拉缝合神经,将对神经干血供产生严重影响.神经束膜缝合比神经外膜缝合更强调在无张力下进行.     

结扎双侧椎动脉对家兔BAEPs的影响

本实验通过对１０只家兔双侧推动脉结扎，观察手术前后脑干听觉诱发电位（ＢＡＥＰｓ）的变化［１］。结果发现：动物在推动脉结扎后，随时间延长ＢＡＥＰｓ各波的波幅逐渐减压，潜伏期逐渐延长；上述变化持续进行４０分钟，以后无大变化。提示：ＢＡＥＰｓ可以客观地反映椎基底动脉的供血情况。本项研究为临床用ＢＡＥＰｓ诊断椎基底动脉供血不足，提供了一项理论依据。     

Isolated unilateral absence of a pulmonary artery: influence of systemic circulation on alveolar capillary vessels

We report a case of isolated unilateral absence of a pulmonary artery. The first clinical symptom that was manifested in the patient was recurrent hemoptysis, and subsequent angiography revealed that the main pulmonary artery was absent in the right lung, which was being fed only from the systemic circulation. Right pneumonectomy was performed, and neither the main pulmonary artery nor its remnant was detected in the resected right lung. Histologically, there were many muscular vessels in the resected lung, with intimal proliferation, or with plexiform-like lesions. The alveolar septum was moderately thickened and alveolar capillary vessels were dilated. We examined the alveolar capillary endothelial cells of the resected lung for immunoreactivity to thrombomodulin (TM) and von Willebrand factor (vWF). The endothelial cells were negative for TM and positive for vWF, while in the normal lung control group, these cells were positive for TM and negative for vWF. We considered that the hemodynamics of the systemic circulation in the resected lung caused the alteration of immunohistochemical characteristics in alveolar capillary endothelial cells.     

Selective accumulation of monoclonal antibodies against neurospecific enolase in brain tissue of rats with middle cerebral artery occlusion

Preparations of I¹²⁵-labeled monoclonal antibodies against neurospecific enolase and mouse plasma IgG1 were injected intravenously to rats immediately after unilateral occlusion of the middle cerebral artery. Radioactivity of I¹²⁵-labeled monoclonal antibodies against neurospecific enolase in the brain tissue progressively increased, reached a maximum by the 48th hour, and remained practically unchanged after 72 h. At the same time radioactivity of labeled IgG1 in the brain tissue and radioactivity of both preparations in the blood, liver, spleen, kidneys, heart, and lungs decreased over 72 h. Selective accumulation of I¹²⁵-labeled monoclonal antibodies against neurospecific enolase was less significant in the brain tissue of the contralateral hemisphere and cerebellum not exposed to ischemia.Translated from Byulleten Eksperimentalnoi Biologii i Meditsiny, Vol. 138, No. 10, pp. 388–392, October, 2004     

高血压鼠动脉壁去甲肾上腺素含量及形态变化研究

取不同年龄组自发性高血压鼠的胸主动脉，颈劝脉和基底动脉，用高效液相色谱－电化学检测仪测定其去甲肾上腺素含量，并取脑软膜血管作超微结构观察，结果显示：各组高血压鼠动有脉壁去甲肾上腺素含量均下降，颈内动脉更明显；脑血管内弹性膜部分断裂，平滑肌细胞有空不包变性等。