Bilocular atrial malignant mesenchymoma causing mitral and localized pulmonary vein flow obstruction: diagnosis by transoesophageal echocardiography.

Cardiac malignant mesenchymoma is an extremely rare malignancy with poor prognosis. We report a patient presenting with a history and clinical findings typical of mitral stenosis. Transthoracic echocardiography showed a mass on the thickened posterior mitral leaflet. Transoesophageal echocardiography revealed two tumoural masses: one on the atrial side of the posterior mitral leaflet causing mitral obstruction, the other arising in the region of the right lower pulmonary vein orifice and obstructing inflow through this vein.     

门静脉海绵样变的手术治疗

目的 探讨门静脉海绵样变的手术治疗方式。方法 对9例门静脉海绵样变患者的14次手术方式进行回顾分析。结果 1例患者剖腹探查无法手术，其余13次手术中，分流手术5次，断流手术8次，对于再出血时间的对比分析，断流手术发生再出血时间长，并与断流的彻底性有关。结论 对于门静脉海绵样变的手术方式以彻底的断流术为佳，最好行贲门周围血管离断 食道下段 胃底切除再吻合术。     

肾病综合征合并肾静脉血栓形成:病因及抗栓治疗进展

肾病综合征患者具有明显的高凝倾向,肾静脉血栓形成是其常见且严重的并发症之一。文中阐述了肾病综合征患者高凝状态的病理生理学基础,对肾静脉血栓的抗栓治疗也做了详尽的综述。     

老年临终病人锁骨下静脉置管的护理

分析老年临终病人的特点,做好锁骨下静脉置管的护理,从而减轻老年临终病人多次穿刺的痛苦。     

肝硬化病人门静脉和肝动脉多谱勒血流参数变化的意义

目的 :探讨肝硬化门脉高压病人门静脉和肝动脉彩色多谱勒血流参数变化的意义。方法 :肝硬化伴食道静脉曲张的病人 6 6例 ,正常人对照组 5 8例。测量门静脉血流速度 (PVV)和肝动脉阻力参数 (HA- PI) ,计算肝血管指数。结果 :在肝硬化门脉高压病人比对照组 PVV明显降低 (12± 2 .2 ) cm/ s;(15 .8± 2 .6 ) cm/ s,P<0 .0 0 1)和 HA- PI明显增高(1.3± 0 .15 ;0 .94± 0 .16 ,P<0 .0 0 1) ,肝血管指数明显减低 [(8.6± 2 .1) cm/ s;(16 .7± 4 .2 ) cm / s,P<0 .0 0 1) ]。彩色多谱勒血流参数 PVV、HA- PI、肝血管指数对肝硬化门脉高压的诊断的敏感性和特异性分别为 89%、84 %、83%、81%、95%、91%。结论 :肝血管指数对肝硬化门脉高压的诊断的敏感性和特异性更高。     

地塞米松对内毒素作用下人脐静脉内皮细胞表达组织因子、凝血酶调节蛋白和蛋白S的影响

目的观察地塞米松(DEX)对内毒素(LPS)作用于人脐静脉内皮细胞(HUVEC)后表达组织因子(TF)、凝血酶调节蛋白(TM)和蛋白S(PS)的影响.方法24孔板培养的第1～5代HUVEC,在含不同浓度LPS和DEX的无血清培养基中培养一定时间后裂解细胞,应用酶联免疫吸附法(ELISA)测定裂解液中的TF、TM和PS含量.结果在LPS刺激下,HUVEC表达TF的量呈剂量依赖性升高,在LPS0.1μg/ml下TF的表达量为对照组的4倍(P＜0.01),同时加入0.5 μg/ml和1.0 μg/ml DEX则可使TF的表达量由128.3±25.7 pg/105细胞分别降至94.9±19.4 pg/105细胞和98.8±7.8 pg/105细胞(P＜0.05);LPS(0.01～10μg/ml)可抑制HUVEC表达TM,在LPS 10 μg/ml下,TM表达量降至对照组的60%(P＜0.05).DEX可拮抗LPS抑制HUVEC表达TM的效应,0.1 μg/ml、0.5 μg/ml和1.0 μg/ml DEX可使LPS(10 μg/ml)作用下TM的表达量由0.282±0.014 ng/105细胞分别增至0.409±0.009、0.462±0.017和0.362±0.019 ng/105细胞(P＜0.05);LPS(0～10 μg/ml)可抑制HUVEC表达PS,在LPS浓度1.0 μg/ml及10 μg/ml时,PS的表达量分别为对照组的43%和38%(P＜0.01).DEX则拮抗LPS抑制HUVEC表达PS的效应,0.5 μg/ml DEX可使LPS刺激下PS的表达量由13.1±4.8%/2×105细胞增至48.5±10.2%/2×105细胞(P＜0.01).结论LPS促进HUVEC表达TF,抑制HUVEC表达TM和PS.DEX能部分拮抗上述作用,提示DEX可能纠正内毒素血症时的高凝状态.     

DAY-ONLY ADMISSION FOR VARICOSE VEIN SURGERY

Day-only admissions for surgery are strongly encouraged, in an effort to keep costs down. Varicose vein surgery has been considered too major for day-only management despite the fact that there have been studies from overseas showing that it can be done with a morbidity comparable to inpatient surgery. The morbidity of day-only surgery for varicose veins (both long and short saphenous procedures) was assessed and compared with the results of inpatient surgery. Patients were also asked whether they were satisfied with the surgery being done this way. There were 165 consecutive patients available for study, 64 day-only and 101 inpatient. All patients attending Shellharbour Hospital, Shellharbour, had surgery done as day-only (as it was a morning list and allowed adequate time for recovery). Patients attending Bulli Hospital, Bulli, had surgery done as an inpatient (afternoon list). All surgery was performed by one surgeon. There was no difference (Chi-squared) in the age distribution (mean 48 years for day-only, 51 years for inpatient) or sex proportion in either group (Chi-squared test of proportions with continuity correction). Assessment of the results was done by review of the surgeon's notes, as well as telephone interviews for day-only subjects. The complication rate in both groups was similar. Wound problems represented the main complication with an incidence of 10.5% in each group. There was one deep venous thrombosis (DVT) in each group (diagnosed by duplex scan). Response to the telephone interview suggested that most patients were happy to have the surgery done as a day-only procedure. Sixty-nine per cent responded that they would have it done this way again and 76% were satisfied with the result of the surgery. This study confirms the results of overseas studies, in that varicose vein surgery can be performed as day-only procedures with a complication rate similar to inpatient procedures and with a high degree of patient satisfaction. It is suggested that this should be used as the method of choice for the majority of patients requiring varicose vein surgery.     

伤肢小隐静脉修复腘动脉损伤解剖基础与临床应用

目的:为利用伤肢小隐静脉修复腘动脉损伤提供解剖学依据。方法:对25具标本50侧肢体的腘动脉和小隐静脉进行解剖研究并分别测量其管径。结果:腘动脉与小隐静脉解剖关系恒定,腘动脉管径起始段为(6.6±0.9)mm,中段为(5.9±1.0)mm,分叉前为(4.9±0.9)mm,小隐静脉管径汇入处为(3.1±0.1)mm,外踝平面和中段管径均为(2.9±0.1)mm,在小腿的上段小隐静脉与大隐静脉和深静脉间交通支出现率低。结论:腘动脉与小隐静脉解剖关系恒定,管径较相近,在伤肢小腿的上段切取一段小隐静脉对静脉回流无明显影响,临床应用21例22侧肢体,效果可靠满意。     

门脉高压性胃病出血的诊断及治疗

目的:探讨门脉高压性胃病出血的机制、诊断及治疗进展,利于今后学习及研究。方法:归纳近几年文献资料。结果:门脉高压性胃病的内镜及组织学表现有特异性。结论:门脉高压性胃病出血是门脉高压患者特有的上消化道出血原因之一,降门脉压治疗是重点。     

肝静脉裂隙在肝脏外科中的应用

目的探讨肝静脉裂隙在肝脏外科的应用。方法30例背驮式肝移植，10例选择性肝静脉阻断切肝术，3例通过肝后隧道建立绕肝阻断带，行右肝叶切除术。结果三种术式都能通过肝静脉裂隙解剖出肝右静脉根部和左、中肝静脉共干，切断肝静脉或阻断肝静脉根部或建立肝后隧道，完成手术。结论肝静脉裂隙是肝静脉根部的重要解剖部位，要解剖出肝静脉根部、解剖肝静脉裂隙是必须的，也是可行、安全、可靠的。