VASCULAR COMPLICATIONS OF ELECTIVE LOWER LUMBAR DISC SURGERY

Lower lumbar disc surgery is an extremely common operation from which vascular complications are reported rarely. However vascular injury can occur with perforation of the anterior longitudinal ligament. External haemorrhage is uncommon and the true cause of the patient's hypotension may be misdiagnosed. If the hypotension is severe or prolonged laparotomy is indicated, to prevent exsanguination and to effect a repair of the vascular injury. Alternatively, if the injury is missed, an arteriovenous fistula may develop; this diagnosis may be delayed for months or years. One case of severe haemorrhage following lower lumbar disc surgery is reported and a further 69 cases of similar arterial injury have been reviewed from the world literature.     

Acute heart failure and acute renal failure in Kawasaki disease

Acute renal failure and acute heart failure are rare in Kawasaki disease. We experienced two patients with Kawasaki disease who presented acute renal failure and acute heart failure. These two patients gave us an important insight into the understanding of water balance and fluid therapy in Kawasaki disease. One patient showed acute prerenal failure due to fluid exudation from the intravascular to the extravascular space, and subsequent acute heart failure. The other patient showed acute heart failure caused by fluid infusion for the treatment of dehydration. It is suggested that acute renal failure could be caused by a fluid shift from the intravascular to the extravascular space in Kawasaki disease. It is also demonstrated that the reserve of cardiac function could be decreased in patients with Kawasaki disease due to myocarditis even with normal echocardiography and chest X-rays.     

Digital sonomicrometer system for measuring small vascular diametersin situ

Although present sonomicrometer techniques for measuring continuous changes in vascular diameter are very useful, two problems with available methods are difficulty in maintaining crystal alignment throughout an acute experiment and inability to measure absolute dimensions less than 1 mm. We have designed and ultrasonic dimension gauge system to over come these problems. The design uses a gate to pass a 20 MHz signal to a counter during the sonic travel time between crystals, and then converts the digital count to an analogue voltage. Interference from the transmitting impulse in the received signal was minimised using MOSFET transistors allowing measurements of absolute dimensions from 0.00 mm to 99.9 mm. An averaging effect which depends upon the asynchrony between the basic timer and the counter clock results in a resolution of at least 10 μm. Repeated calibration curves showed an accuracy of 2.5 μm without significant bias. Piezoelectric crystals were mounted to a lighweight stainless-steel clip to facilitate attachment to the vessel and to maintain the crystals in focus during changes in diameter. Mean and phasic diameters measured in the femoral artery with the clip device correlated well with measurements obtained with crystals sewn to the adventitia of the femoral artery of the dog (slope =0.97, r=0.99).     

乳腺癌患者血清Leptin和VEGF的表达

目的：研究瘦素（Leptin）、血管内皮生长因子（VEGF）在乳腺癌患者血清中的表达，探讨其在乳腺癌诊断中的意义。方法：选择乳腺癌患者36例，乳腺良性增生病变患者31例，另选56例健康女性作为对照。分别用放射免疫分析（RIA）和酶联免疫吸附试验（ELISA）测定这些患者术前血清Leptin、VEGF。结果：正常对照组与良性病变组、乳腺癌组Leptin存在明显差异，正常对照组与乳腺癌组，良性病变组与乳腺癌组VEGF存在明显差异。乳腺癌患者术前血清Leptin、VEGF含量与有无淋巴结转移具有相关性。结论：乳腺癌患者术前血清Leptin、VEGF可作为鉴别乳腺良恶性肿瘤有无转移的指标。     

新型血管吻合用支架对血管内膜的影响

目的：研制一种可溶性血管内支架辅助血管断端吻合，并检测该支架在血管吻合的过程中对血管内膜的影响。方法：选用高纯度低分子量明胶为主要原料制备血管吻合用支架，利用该支架进行血管吻合操作，观察支架对血管内膜的作用，并从超微结构方面进行研究。结果：明胶类可容性血管内支架表面光滑，在血管吻合的过程中不会对血管壁造成损伤；与同类支架相比具有明显的优势。结论：明胶类可溶性血管内支架具有光滑的外表面，适合于进行血管吻合操作。     

脑动静脉畸形血管重构的分子生物学机制

脑动静脉畸形存在活跃的血管重构,本文就其重构的分子生物学机制作一综述。     

Histamine differentially interacts with tumor necrosis factor-α and thrombin in endothelial tissue factor induction: the role of c-Jun NH2-terminal kinase

BACKGROUND: Histamine plays an important role in vascular disease. Tissue factor (TF) expression is induced in vascular inflammation and acute coronary syndromes. OBJECTIVES: This study examined the effect of histamine on tumor necrosis factor-alpha- (TNF-alpha-) vs. thrombin-induced endothelial TF expression. METHODS AND RESULTS: Histamine (10(-8)-10(-5) mol L-1), TNF-alpha (5 ng mL-1), and thrombin (1 U mL-1) induced TF expression in human endothelial cells. Although TF expression by TNF-alpha and thrombin was identical, histamine augmented TNF-alpha-induced expression 7.0-fold, but thrombin-induced expression only 2.6-fold. Similar responses occurred with TF activity. The H1-receptor antagonist mepyramine abrogated these effects. Differential augmentation by histamine was also observed at the mRNA level. Histamine-induced p38 activation preceded a weak second activation to both TNF-alpha and thrombin. Histamine-induced c-Jun NH2-terminal kinase (JNK) activation was followed by a strong second activation to TNF-alpha, and less to thrombin. Selective inhibition of this second JNK activation by SP600125 reduced TF induction to histamine plus TNF-alpha by 67%, but to histamine plus thrombin by only 32%. Histamine augmented TNF-alpha- and thrombin-induced vascular cell adhesion molecule 1 (VCAM-1) expression to a similar extent. Consistent with this observation, VCAM-1 induction to TNF-alpha and thrombin was mediated by p38, but not by JNK. CONCLUSIONS: Histamine differentially augments TNF-alpha- vs. thrombin-induced TF expression and activity, which is mediated by the H1-receptor, occurs at the mRNA level, and is related to differential JNK activation.