3-D echocardiographic imaging of double aortic arch.

Delineation of arch abnormalities is difficult by conventional 2-D echocardiography and MRI has been the investigation of choice. 3-D echocardiography is increasingly used in congenital heart disease for both functional anatomy and morphology. This case report demonstrates that 3-D echocardiography can be used in delineating arch anomalies, which can avoid further imaging that needs a general anaesthetic.     

Anterior Communicating Artery Aneurysm Following Radiation Therapy for Optic Glioma: Report of a Case and Review of the Literature

A 42-year-old female presented with subarachnoid hemorrhage (SAH), presumably from a radiation-induced anterior communicating artery aneurysm. Six years earlier, she had undergone radiation treatment for an optic glioma that was diagnosed based on imaging criteria. The aneurysm was successfully clipped, and the optic glioma was biopsied to verify the diagnosis histologically. Radiation-induced cerebral aneurysms often manifest with a fatal SAH. These aneurysms typically develop in the field of radiation and are diagnosed a mean of 8.52 years after radiation. Rarely, the aneurysm sac thromboses spontaneously. Clipping or coiling of the aneurysm can be an effective treatment.     

脑动脉瘤夹闭术与栓塞术:竞争还是互补?

目的探讨颅内动脉瘤开颅夹闭术和介入栓塞术两种治疗方式的相互关系。方法回顾总结动脉瘤夹闭术和栓塞术互补性治疗的6例病例，其中3例先行手术治疗，3例先行介入治疗。3例手术治疗的患者其中1例出现后交通动脉瘤复发，1例前交通动脉瘤术后前交通动脉上发现新的动脉瘤，均行动脉瘤栓塞术补充治疗，1例双侧后交通动脉瘤左侧手术夹闭1年后行右侧后交通动脉瘤颅内支架血管内介入治疗。3例先介入治疗的患者中1例发生栓塞物堵塞载瘤动脉瘤导致大面积脑梗塞，1例发生栓塞物移位，1例发生再出血，均采取开颅手术予以补充治疗，夹闭动脉瘤并取出了栓塞物。结果所有补充治疗均未造成新的病残，其中5例恢复满意，1例恢复良好。结论颅内动脉瘤夹闭术和栓塞术之间既是竞争的关系同时也是互补的关系，两种手术方式都有需要发展的余地同时也有相互结合的必要。     

鸡胚第一对弓动脉的发生

用印地安墨汁注入活体鸡胚心脏，在体现显微镜下观察１１２例第１０～２０期鸡胚第一对弓动脉的发生。第一对弓动脉于第１０期出现，至第２０期退化消失。第一对弓动脉出现时尚无相应的第一咽弓，随着第一咽弓的出现，第一对弓动脉的起始端形成一个突入第一咽弓内的动脉瘤样隆起，此隆起随着第一咽弓的增大逐渐发育成一对贯穿第一咽弓的弓状血管。第一对弓动脉可以分为位于第一咽弓内的近侧段和位于此咽弓之外，与背主动脉相连的远侧段。     

Imaging of thoracic aortic dissection

Acute thoracic aortic dissection has a high mortality if untreated, so the diagnosis must be rapidly made if mortality is to be lowered significantly. Multiple imaging techniques are often used. This retrospective study from 1988 to 1993 assesses the usefulness in diagnosis of chest X-rays, computed tomography (CT) scanning, aortography, magnetic resonance imaging (MRI), trans-thoracic (TTE) and trans-oesophageal (TOE) echocardiography. Forty-two patients with a final clinical diagnosis of dissection were studied. The diagnosis was confirmed in 16 (13 at surgery and three at autopsy). Three died with dissection given as the only cause for death. Chest X-ray abnormalities were seen in all 19 patients with surgery or death from dissection, with a widened mediastinum and/or dilated aorta being present in 17. In the group of 16 patients with surgery or autopsy proof, CT scans found dissections in 9 of 12 patients studied and correctly classified the type in only five. Aortography was performed in five, with accurate depiction of dissection and type in all. TTE found dissections in three of eight patients imaged by this method. MRI and TOE were performed each on two patients, with accurate depiction of dissection and type in each. Because of the relatively low sensitivity of CT scanning in defining aortic dissections Westmead Hospital is currently assessing the use of TOE as the prime imaging modality prior to surgical intervention.     

老年主动脉瓣闭锁不全的彩色多普勒超声心动图研究

报告接受彩色多普勒超声心动图检查的老年患者162例，其中75例有不同程度的主要动脉瓣关闭不全（Ar)。老年（Ar)的病因构成与中，老年前期者明显不同，主动脉，瓣钙化及原因不明者的比例占多数（67％）。主动脉瓣钙化者Ar程度多较重。主动脉瓣钙化及原因不明Ar患者的其他三个瓣膜返流检出率及和程度均明显高于无Ar的老年患者。表明多瓣膜退行性病变是此类Ar患者的原因之一。     

淫羊藿总黄酮对肾上腺素β_1受体的特异性阻断作用

为探讨淫羊藿总黄酮（ＴＦＥ）对肾上腺素受体的作用，本实验用离体兔心房肌、主动脉及豚鼠气管观察了ＴＦＥ对肾上腺素全体的作用，结果ＴＦＥ（０．１３ｇ／Ｌ）抑制心房肌肌力和频率，并使异丙肾上腺素（ＩＳＯ）对心房肌正性频率作用的量效曲线平行右移，但无钙拮抗作用及Ｍ受体激动效应，且不影响ＩＳＯ对豚鼠气管条的负性肌力作用及去甲肾上腺囊（ＮＥ）对兔主动脉条的收缩作用。提示ＴＦＥ选择性阻断肾上腺素β_１受体。     

脑动脉瘤破裂伴发急性硬膜下血肿的诊治

目的 探讨脑动脉瘤(AN)破裂所致的急性硬膜下血肿(ASDH)的临床、影像学特点和诊治方案。方法 回顾288例破裂AN，发现10例伴有ASDH。Huni Hess分级，Ⅱ级3人，Ⅲ级1人，Ⅳ级3人，Ⅴ级3人，均经CTA诊断为AN破裂，除2例外均被脑血管造影或手术所证实。保守治疗2例，血肿清除加AN夹闭术4例，电解脱弹簧圈(GDC)栓塞后加血肿清除2例，栓塞加脑室外引流1例，单纯栓塞l例。结果 疗效优者2例，中残者l例，7例死亡。结论 AN性ASDH的预后极差，同术前分级相关；CTA检查后立即行血肿清除加动脉瘤夹闭有助于提高预后，合适患者可联合栓塞和血肿清除术。     

颅内后循环远端动脉瘤的介入治疗

目的回顾性分析20例以电熔断解脱弹簧圈栓塞的后循环远端动脉瘤的治疗结果,探讨颅内动脉后循环远端动脉瘤的介入治疗方法与安全性。方法20例患者(其中18例以自发性蛛网膜下腔出血起病,2例以头痛起病)经造影证实大脑后动脉、小脑上动脉、小脑前下动脉、小脑后下动脉之远端动脉瘤分别为2例、4例、4例、10例。其中小脑上动脉供血之动静脉畸形1例,伴有血流相关破裂动脉瘤。小脑后下动脉远端多发动脉瘤1例。所有动脉瘤均采用GDC、EDC或Matrix弹簧圈栓塞。其中单纯栓塞动脉瘤2例;栓塞动脉瘤同时栓塞载瘤动脉18例。结果所有病例栓塞操作均顺利完成,无手术相关的死亡,术后出现一过性功能障碍2例;载瘤动脉栓塞后多数可见侧支供血,未见叫显的小脑供血减少。结论后循环远端动脉瘤由于动脉瘤特性、载瘤动脉细小、动脉瘤与载瘤动脉比例等因素,多需要闭塞载瘤动脉。为避免可能造成的侧支血管的闭塞,建议用弹簧圈栓塞。     

Balloon occlusion of the internal carotid artery in 40 cases of giant intracavernous aneurysm: technical aspects,cerebral monitoring,and results

Summary We have studied the results of carotid occlusion in the treatment of giant intracavernous carotid artery (ICA) aneurysms in 40 patients. Clinical, angiographic, Doppler and cerebral blood flow (CBF) criteria for tolerance of occlusion are discussed. The patients had headaches (47.5%), cranial nerve compression (87.5%), decreased visual acuity (20%), ruptured aneurysm (15%) and 5% were asymptomatic. Balloon occlusion tests were performed under light sedation anaesthesia: a successful test required perfect clinical tolerance and adequate angiographic collateral circulation in arterial, parenchymatous, and venous phases. Additional criteria include xenon 133 CBF measurements, and transcranial Doppler sonography of the middle cerebral artery. According to these criteria, 5 patients did not tolerate test occlusion and required an extra-intracranial (EC-IC) bypass. Mean follow-up was 4.7 years. All patients were radiologically cured of their ancurysm, and in 35 the symptoms resolved, although 3 had persistent ocular motor nerve palsies, and in 4 visual defects were unchanged. Complications were 1 permanent and 3 transient neurological deficits. Balloon occlusion of the ICA is an effective, reliable form of treatment for intracavernous giant aneurysm and should replace surgical ligation of the cervical carotid artery. With CBF or Doppler monitoring, the risk of neurological deficit is diminished. EC-IC bypass prior to ICA occlusion is indicated if test occlusion is not tolerated.