简易定向锥颅脑内血肿碎吸术治疗高血压脑出血——介绍一种简易脑内血肿碎吸器的研制及临床应用

本文介绍一种高血压脑出血外科治疗的新方法,即简易定向锥颅脑内血肿碎吸术。截至1988年10月临床应用19例,年龄41～79岁,出血量平均为48.1ml,一次吸除量为总量的79％(38ml),术后立即清醒者8/19例,偏瘫好转者4/19例,死亡4例。实践证明本法简单,安全有效,病人负担轻。     

Differences in Left Ventricular Twist Related to Age: Speckle Tracking Echocardiographic Data for Healthy Volunteers from Neonate to Age 70 Years

Objective: To determine normal left ventricular (LV) twist characteristics in different age groups and assess changes between neonates and the elderly. Methods: Short‐axis left ventricle images at basal and apical levels were acquired in 274 healthy volunteers (aged 15 days to 72 years) by two‐dimensional echocardiography, and were analyzed off‐line using Speckle tracking echocardiography (STE) software to obtain LV twist measurements. The peak apical rotation (PAr), peak basal rotation (PBr), peak LV twist (Ptw), peak LV twist normalized by LV length (Ptw N ), peak untwisting velocity (PutwV), and isovolumic untwisting% (Iutw%) were measured. Results: LV twist values vary with age. Ptw was higher in older volunteers. PtwN varied inconsistently with age. PutwV and Iutw% were lower in the young and old with a peak in mid–age ranges. Conclusions: STE is an effective noninvasive method to assess LV twist. Age‐related differences in LV twist may reflect maturation and adaptive modulation of LV torsional biomechanics from neonate to the elderly. (Echocardiography 2010;27:1205‐1210)     

Left Ventricular Torsion Parameters are Affected by Acute Changes in Load

Background: Quantification of left ventricular torsion may provide new indices of systolic and diastolic function. We sought to characterize the effect of acute manipulation of load on cardiac torsion, plecotropy in human subjects. Methods: Simultaneous Millar LV pressure, micromanometry, and echocardiograms were performed on 18 patients (10 male, mean age 66 years) with normal systolic function. Loading was altered sequentially by the administration of glyceryl trinitrate (GTN) and saline fluid loading. Echocardiographic speckle tracking imaging was used to quantify LV torsion and event timing was recorded relative to mitral valve opening (MVO). Results: GTN administration decreased preload (LV end diastolic pressure: 15.7 vs 8.4 mmHg, P < 0.001), and afterload (wall stress: 140 vs 84 ×10³dyn/cm², P < 0.02). Administration of fluid increased preload (LVEDP 11.3 vs 18.1 mmHg, P < 0.001) and increased wall stress, but to a lesser extent (102 vs 117 ×10³dyn/cm², P < 0.003). GTN administration augmented peak torsion (8.4 vs 11.0 deg, P < 0.05), increased systolic torsion velocity (46.6 vs 65.3deg/sec, P < 0.01) and resulted in earlier onset of untwisting (–105 vs –127ms, P < 0.05). Fluid loading decreased the proportion of untwisting prior to MVO (39.0 vs 31.0%, P < 0.05), untwisting acceleration (–750 vs –592deg/sec/sec, P < 0.05) and delayed the timing of peak untwisting (–37.0 vs 9.1ms, P < 0.01), but did not affect systolic torsion parameters. Conclusions: Left ventricular torsion parameters are sensitive to acute changes in load and therefore need to be interpreted in the context of current loading conditions. (ECHOCARDIOGRAPHY 2010;27:407‐414)     

Effect of exercise training on left ventricular mechanics after acute myocardial infarction–an exploratory study

Background

Cardiac rehabilitation (CR) exercise training is beneficial after myocardial infarction (MI). Whilst the peripheral adaptations to training are well defined, little is known regarding the effect on left ventricular (LV) remodelling, particularly LV function. Efficient LV ejection and filling is achieved through deformation and rotation of the myocardium in systole and diastole – LV mechanics. The response of LV mechanics to CR exercise training in MI patients is unknown.

Evaluation of Smeared Constitutive Laws for Tensile Concrete to Predict the Cracking of RC Beams under Torsion with Smeared Truss Model

In this study, the generalized softened variable angle truss-model (GSVATM) is used to predict the response of reinforced concrete (RC) beams under torsion at the early loading stages, namely the transition from the uncracked to the cracked stage. Being a 3-dimensional smeared truss model, the GSVATM must incorporate smeared constitutive laws for the materials, namely for the tensile concrete. Different smeared constitutive laws for tensile concrete can be found in the literature, which could lead to different predictions for the torsional response of RC beams at the earlier stages. Hence, the GSVATM is used to check several smeared constitutive laws for tensile concrete proposed in previous studies. The studied parameters are the cracking torque and the corresponding twist. The predictions of these parameters from the GSVATM are compared with the experimental results from several reported tests on RC beams under torsion. From the obtained results and the performed comparative analyses, one of the checked smeared constitutive laws for tensile concrete was found to lead to good predictions for the cracking torque of the RC beams regardless of the cross-section type (plain or hollow). Such a result could be useful to help with choosing the best constitutive laws to be incorporated into the smeared truss models to predict the response of RC beams under torsion.     

Percutaneous retrieval of a twisted guide catheter using a longer second radial sheath

Coronary angiography and percutaneous coronary intervention (PCI) over the radial approach are becoming more frequent and are recommended by the European Association of Percutaneous Cardiovascular Interventions and European Society of Cardiology. The radial approach leads to less bleeding and improved survival in ST‐segment elevation myocardial infarction. Pronounced guide catheter manipulation in cases with tortuous access routes and requirement of extra backup during complex PCI may structurally damage the guide shaft and facilitate twisting and bending. We present three cases where a twisted coronary catheter became stuck in the radial artery and describe a minimally invasive retrieval technique using a second introducer sheath of same French (F) size and greater length. © 2013 Wiley Periodicals, Inc.