Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

罕见的囊性A型胸腺瘤1例

病人男,56岁。体检时发现前上纵隔肿瘤10d。病人无咳嗽、咳痰、咯血、呼吸困难及胸痛等症状。查体:气管居中,胸廓无畸形,胸骨无压痛。胸部CT检查示“前上纵隔囊性肿块,大小约11cm×6cm×3cm,性质待查”。B超检查“肝、胆、胰、脾未见明显占位”。2004年12月,入院后5d在全麻下行“前上纵隔肿块切除术”,术中见肿瘤约11cm×6cm×3cm大小,呈囊性,肿瘤与左纵隔胸膜有轻度粘连,分离胸膜,完整切除肿瘤,切除标本送病理检查。病理检查:囊性肿物,11cm×6cm×3cm大小,表面灰白、灰黄、灰褐色,切面可见3个大小不等的囊,分别为5.5cm×3.2cm、4.5cm×3.…     

冬天吃南瓜美味又健康

现代生活中,吃南瓜成为都市人的一种时尚。的确,冬天是吃南瓜的好时节。理由一:应景源自于古英格兰和爱尔兰的塞尔特民族的万圣节,这项在当时称作Sam hain的庆典意味着收成的结束与冬季的来临。在这一天,小朋友们会装扮成女巫或者精灵,手上提着南瓜灯笼,挨家挨户地模仿妖怪来索     

血管内介入治疗颅内巨大动脉瘤23例报告

颅内巨大动脉瘤是指最大直径大于25 mm的动脉瘤,治疗仍十分困难,我们采用血管内介入治疗23例颅内巨大动脉瘤病人,并取得良好效果,现结合有关文献分析报告如下.     

脊髓血管畸形血管内皮生长因子在脑脊液的表达

目的探讨脊髓血管畸形是否存在血管内皮生长因子(VEGF)表达,及其表达与临床特征之间是否存在相关性。方法在手术中留取56例脊髓血管畸形的脑脊液标本,其中动静脉畸形(SCAVM)23例,硬脊膜动静脉瘘(SDAVF)19例,海绵状血管瘤(CM)14例;以我院12例蛛网膜下腔阻滞病人脑脊液作为对照组,分别通过酶联免疫吸附方法(ELISA)测定脊髓血管畸形脑脊液中VEGF含量。结果SCAVM脑脊液中VEGF浓度为(277±66)pg/ml、SDAVF为(318±54)pg/ml、CM为(146±32)pg/ml均高于正常对照组(123±27)pg/ml。术前栓塞和出血均可导致脑脊液VEGF升高。结论VEGF与脊髓血管畸形的发生、发展存在一定关系,出血和栓塞均可影响VEGF的表达。     

腔内钬激光治疗浅表性膀胱癌(附112例报告)

目的：探讨腔内钬激光治疗浅表性膀胱癌的疗效及安全性。方法：对112例浅表膀胱癌患者行经尿道钬激光治疗，其中16例合并前列腺增生症（BPH）者，同时行经尿道前列腺钬激光切除术。结果：112例膀胱肿瘤均一次切除，平均手术时间30min。无膀胱穿孔。术后平均留置尿管36h。随访3月-19月，平均13月，复发7例（6.3%)。结论：经尿道脸内治疗膀胱癌，操作简便，效果好，复发率低，是一种较好的治疗膀胱癌的方法。     

大动脉调转术后早期循环支持

目的　总结分析复杂先天性心脏病患者行大动脉调转术后早期的循环功能特点及循环支持的经验。　方法　回顾性分析 2 0 0 0年 1月至 2 0 0 2年 12月本院收治的 32例患者临床资料 ,术后均经联合应用正性肌力药、适当利尿、短期肾脏替代治疗及延迟关胸等综合治疗 ,维持循环功能稳定。　结果　死亡 7例 ,存活 2 5例 ,其中安装永久性起搏器 2例。术后随访 6～ 36个月 ,存活患者心肺功能正常。　结论　术后早期有效的循环支持是提高术后存活率及患者远期生活质量的关键     

钬激光腔内治疗泌尿系结石(附126例报告)

目的：探讨泌尿系结石腔内钬激光治疗效果及安全性。方法：总结钬激光结合腔内泌尿外科技术治疗126例泌尿系结石的临床资料。结果：5例肾结石和11例膀胱结石，均一次碎石成功，109例输尿管结石，单次碎石率为96.3%(105/109)，复杂结石1例数次行输尿管腔镜下碎石。平均结石排净时间2.8周，平均手术时间30min，平均术后住院2d。术中除1例输尿管穿孔外，无其他并发症。结论：钬激光结合腔内泌尿外科技术治疗泌尿系结石，是一种较新的、安全的、有效的方法。     

血小板聚集实验的常见影响因素

血小板聚集试验(PAgT)是化验室常做的项目,但其结果易受许多因素影响。要注意患者情绪、止血带压力、穿刺技术、抗凝剂的正确使用等。采血前禁止吸烟、饮酒、禁服阿司匹林等抑制血小板聚集、释放的药物,以保证结果的准确性。     

经单侧椎板开窗夹闭硬脊膜动静脉瘘

目的　总结经单侧椎板开窗入路夹闭硬脊膜动静脉瘘的经验。方法　回顾性分析了 5 6例经脊髓MR和脊髓血管造影确诊的硬脊膜动静脉瘘患者经单侧椎板开窗夹闭瘘口的临床资料。结果　 5 4例患者术后行脊髓血管造影复查 ,显示瘘口全部消失。 38例患者术后 6个月行脊髓MR复查 ,显示脊髓周围的血管流空影完全消失 ,T2 像髓内高信号影消失或明显减少。 5 4例患者获随访 ,随访时间 3～ 36个月 ,2 4例症状完全消失 ,2 7例症状改善 ,3例无变化。结论　经单侧椎板开窗夹闭瘘口的手术方法是硬脊膜动静脉瘘的首选治疗方法。