Objective To explore the diagnosis and treatment of ruptured abdominal aortic aneurysm (RAAA). Methods Between January 1996 and December 2009, 14 patients with RAAA were treated. There were 13 males and 1 female with an average age of 65 years (range, 50-82 years). The main cl inical manifestations were abdominal pain and/or back pain. Ten cases had low blood pressure or shock. All cases were accurately diagnosed with CT, Doppler ultrasonography,or operation. The aneurysm diameter was from 4.5 cm to 8.0 cm. Eleven cases were treated by conventional operation, 1 by endovascular aortic repair, 1 by conservative treatment, and 1 case died after admission treatment. Results Perioperative death occurred in 6 cases (mortal ity rate was 50%) in 12 surgical patients. One case died after conservative treatment. The overall mortal ity rate was 57.14% (8/14). The causes of death included circulatory failure in 2 cases and multiple organ failure in 4 cases. The other 6 cases were cured. The postoperative hospital ization days were 12 to 34 days (14 days on average). A total of 4 cases were followed up 11 to 40 months without related compl ication. Conclusion Surgical treatment is still a main method to treat RAAA. Early diagnosis, appropriate resuscitation, and urgent surgical repair are crucial to reduce the mortal ity rate of RAAA.
目的 探讨原发性主动脉消化道瘘的诊断和治疗。方法 报道1例原发性主动脉消化道瘘的诊治经过,并复习有关文献。结果 本例为67岁男性患者,以“腹部不适伴反复便血7个月”入院。急诊行剖腹探查，结合术中肠镜发现腹主动脉瘤十二指肠瘘。十二指肠第3段瘘口用5-0普理灵修补缝合； 行腹主动脉瘤切除，用16 mm×8 mm分叉涤纶人造血管行腹主动脉-人造血管-左髂总动脉、右髂外动脉吻合。术后静脉使用三代头孢抗生素3周,后改用口服抗生素，无发热，切口一期愈合，顺利出院。结论 原发性主动脉消化道瘘罕见、死亡率高,应注意与主动脉瘤患者的消化道出血鉴别。及时诊断和快速外科治疗是提高存活率的关键。
目的 探讨血管介入治疗在急性动脉缺血性肠病早期阶段的价值及应用方法。方法 笔者所在医院2005年8月至2011年12月期间共收治急性动脉缺血性肠病患者9例，其中2008年以前的6例行传统开腹手术治疗，2008年以后的3例患者，在短期内确诊并及时进行了溶栓或取栓治疗。结果 开腹手术治疗的6例患者中，行单纯肠系膜上动脉取栓1例，单纯坏死肠管切除3例，肠系膜上动脉取栓加坏死肠管切除2例；手术后1周内死亡2例（死于多脏器功能衰竭），半年后因短肠综合征死亡1例。行介入治疗的3例患者中，行经导管溶栓治疗2例，球囊取栓加溶栓治疗1例；术后均恢复良好，顺利出院； 术后分别随访6个月、9个月和2年，其中1例术后9个月因脑梗塞死亡。结论 血管介入治疗在急性动脉缺血性肠病的早期诊治方面具有明显的优势，一旦有可疑患者，应迅速进行影像学和血液学方面的检查以明确诊断，非创伤性血管成像技术（CTA）和血管造影（DSA）被认为是最有价值的诊断方法。明确诊断后，专业的血管外科医师的早期干预可以明显改善患者的预后。
Objective To evaluate improved effect for deep venous valve function after superficial vein surgery of lower extremity in the intermediate stage. Methods Totally 43 patients (55 limbs) with varicose veins of lower extremity were enrolled to accept surgical management of vein systems in our department from March 2006 to October 2006. All patients were respectively followed up after 6 months and 4 years about the changes of deep venous valve function with color Doppler ultrasonography. Results Thirty-nine patients’ deep venous valve function kept well up to now, and there was no significant difference between the two results. Four patients without proximal saphenous vein ligation recurred, and there was reflux in deep venous. Conclusion Endovenous laser treatment and ablation of varicose veins of lower extremity with deep venous insufficiency could improve deep venous valve function effectively. Proximal great saphenous vein ligation is important for successful operation.
【Abstract】 Objective To investigate the manufacture and biocompatibil ity of a bioabsorbable poly-D,L-lactic acid(PDLLA) plate containing rhBMP-2. Methods rhBMP-2 was composited with PDLLA (0.05 mg/plate) through vacuum to repare PDLLA plate containing rhBMP-2. Thirty-two New Zealand rabbits (male or female) weighted (3.0 ± 0.5) kg were used in he study. A 2.5 mm middle ulna osteotomy was made bilaterally. The bones as well as periosteum were removed. The right side of all the animals was experimental side (n=32), was fixed internally by PDLLA plate containing rhBMP-2.The left side of all the animals was control side (n=32), was fixed by common PDLLA plate. After a follow-up of 2, 4, 8 and 12 weeks, the ulnas were examined visually, radiographically, histologically, and by computer graph analysis to compare the biocompatibil ity. Re sults Po rosity of PDLLA plate containing rhBMP-2 was 90%, aperture was 150 μm, tensile strength was higher than 50 MPa, three point flexural strength was higher than 90 MPa and intrinsic viscosity was 1.6 dL/g (chloroform solvent). All animals had a good heal ing 1 or 2 weeks after operation. All the animal’s diet and movement were normal. All the fractures were stable. The plates in the experimental group degraded faster than those in the control group. Relative values of callus density evaluated by X-ray at 2, 4, 8 and 12 weeks after operation in the experimental group were 39.22 ± 2.48, 48.79 ± 1.26, 63.78 ± 1.78 and 78.60 ± 1.25 respectively. Those in the control defects were 33.83 ± 1.13, 41.28 ± 1.25, 55.23 ± 0.68 and 66.54 ± 1.33. At each time point, the experimental side produced better and more trabeculae than the control side did (P ＜ 0.01). Histological examination showed that the newbone formation in the experimental side at 2, 4, 8 and 12 weeks after operation was 0.106% ± 0.015%, 0.292% ± 0.019%, 0.457% ± 0.048% and 0.601% ± 0.037%, while those in the control side was 0, 0.193% ± 0.019%, 0.339% ± 0.029% and 0.574% ± 0.047%respectively. At each time point, the experimental side produced better new bone formation than the control side did (P lt; 0.05). The experimental side showed better compatibil ity between plates and surrounding tissue, faster bone formation, more bone regeneration mass and better medullary canal structure than the control side. Conclusion PDLLA plate containing rhBMP-2 has good biocompatibil ity and osteoinducibil ity to enhance fracture heal ing.
Objective To explore the clinical experience on treatment of thromboangitis obliterans (TAO) by embolectomy. Methods Fourteen of 121 patients with TAO treated in our hospital from March 2000 to March 2010 were included in this study. Total 14 limbs consisted of 2 upper extremities and 12 lower extremities. Among these cases, 8 cases underwent embolectomy and 6 cases received embolectomy combined the stem cell transplantation. Results Of 14 cases of TAO patients, 11 cases were successfully treated by surgery and 3 cases failed. After successful operation, patient’s pain disappeared and anklebrachial index improved obviously. Seven patients treated successfully by surgery were followed up from 5 months to 8.5 years (mean 4 years), in whom the intermittent claudication and rest pain disappeared in 4 cases, and disease deteriorated in 2 cases who always smoked, and one case had intermittent claudication who stopped smoking. For 3 cases patients failed to operation, one lost followup, one had to receive a below knee amputation due to keep smoking after operation, and one case who stopped smoking underwent alleviative symptoms for 3 years. Conclusion Embolectomy is a safe and effective technique for treating TAO.
ObjectiveTo discuss the scientific research and application value of the new China Association Against Epilepsy (CAAE) EEG reporting system, and to explore the model of establishing EEG database of tertiary comprehensive epilepsy center. MethodsA retrospective study was performed on outpatients who underwent EEG examination at the Epilepsy Center of Tsinghua University Yuquan Hospital from May 2021 to May 2022, and who also received EEG reports using the CAAE new EEG reporting system. We integrated the data of these 6380 patients with the previous database of our Epilepsy Center, and combined the two for the preliminary big data analysis. Results Among 6380 patients, normal EEG was reported in 2253 cases (35.3%) ,abnormal EEG in 4031 cases (63.2%), no definite abnormality in 96 cases. According to age groups, there were 3290 cases in children (51.0%), 1372 cases in adults (22.0%), 753 cases in adolescents (12.0%), 730 cases in infants (11.0%) and 235 cases in infants (4.0%).A total of 1466 (23.0%) patients were recorded with paroxysmal events, including 874 (60.0%) epileptic events. 517 (35.0%) non-epileptic events. ConclusionThe new EEG reporting system can provide a large number of researchable EEG data to guide clinical work, and it is an important tool for data sharing and big data research in the future.