山莨菪碱白蛋白微球与明胶海绵颗粒行子宫动脉栓塞的比较★

背景：子宫动脉栓塞治疗子宫肌瘤常出现腹部痉挛性疼痛，影响了这一技术的开展。目前常用栓塞剂有聚乙烯醇、明胶海绵、真丝线段、钢圈等。 目的：以明胶海绵为对照，观察山莨菪碱白蛋白微球子宫动脉栓塞的效果及对子宫收缩的影响。 设计、时间及地点：自身交叉对照实验，于1999-10/2001-05在解放军总医院第二附属医院实验室完成。 材料：选用月龄12~18个月雌性杂种犬10只。采用加热固化法制备山莨菪碱微球。将实验犬按随机数字表法分为2组，先行明胶海绵栓塞组和先行山莨菪碱微球栓塞组，每组5只。 方法：各实验犬栓塞前肌注宫缩素，宫腔造影观察并记录子宫痉挛频率，作为子宫收缩的参照标准。先行明胶海绵栓塞组先用明胶海绵颗粒为栓塞剂，行一侧髂内动脉造影及栓塞，15 d后采用山莨菪碱微球行选择性对侧髂内动脉栓塞。15 d后切除子宫观察大体和镜下病理改变。先行山莨菪碱微球栓塞组操作同上，只是一侧髂内动脉先用山莨菪碱微球栓塞，另一侧后用明胶海绵颗粒栓塞。 主要观察指标：每次栓塞后1，3，24 h造影观察动脉栓塞情况及宫缩情况；病理观察子宫组织坏死情况和范围。 结果：10只实验犬肌注宫缩素后8只出现宫缩。先行明胶海绵栓塞组实验犬5只，明胶海绵颗粒子宫动脉栓塞后4只出现宫缩，动脉造影显示山莨菪碱白蛋白微球具有栓塞作用，栓塞后实验犬均未出现宫缩；先行山莨菪碱微球栓塞组实验犬5只，山莨菪碱白蛋白微球子宫动脉栓塞后实验犬均未出现宫缩，明胶海绵颗粒子宫动脉栓塞后5只出现宫缩。子宫病理观察大体标本均未见明显坏死，镜下见小动脉内有微球栓塞及血栓形成，子宫内膜坏死。 结论：明胶海绵子宫动脉栓塞可引起较为强烈的子宫痉挛，山莨菪碱白蛋白微球可缓解动脉栓塞所致剧烈宫缩。     

术前超选择栓塞富血运脑膜瘤的临床疗效分析

目的 探讨在术前对富血运脑膜瘤进行介入经动脉超选择栓塞的安全性、疗效及应用价值。方法 回顾性分析在本院治疗的34例脑膜瘤患者,术前均经全脑血管造影(DSA)证实为富血运脑膜瘤,其中12例使用明胶海绵栓塞,15例使用PVA颗粒栓塞,7例未经栓塞直接手术,栓塞3～5 d后进行开颅手术切除肿瘤,记录患者的栓塞程度、开颅切除肿瘤的出血量及肿瘤切除程度。结果 栓塞术后明胶海绵组肿瘤染色完全消失3例,大部分消失9例; PVA颗粒组肿瘤染色完全消失9例,大部分消失6例; 2组比较有明显差异(P<0.05); 2组无与介入栓塞相关的严重并发症发生。PVA组出血量为(350±135)mL,明胶海绵组出血量为(475±265)mL,未栓塞组出血量为(660±350)mL,3组间两两比较均有明显差异(P<0.05)。PVA组肿瘤全切14例,次全切除1例; 明胶海绵组全切11例,次全切除1例; 未栓塞组全切7例,次全切0例。结论 富血运脑膜瘤在术前进行介入栓塞能减少术中出血,降低全切难度,但并未能明显提高全切率,对于栓塞材料而言,PVA颗粒的栓塞效果比明胶海绵颗粒更好,两者均可作为富血运脑膜瘤切除术前栓塞的材料使用,术前的介入栓塞能作为富血运脑膜瘤的一项可行的辅助措施。     

颌内动脉栓塞术与鼻内镜下鼻腔电凝止血术治疗鼻出血合并脑梗死的随机对照研究

目的探讨颌内动脉栓塞术与鼻内镜下鼻腔电凝止血术治疗鼻出血合并脑梗死的临床疗效。方法收集2005-01—2014-01间我院收治的鼻出血合并脑梗死患者32例,随机分为观察组与对照组各16例。观察组采用颌内动脉栓塞术治疗,对照组采用鼻内镜下鼻腔电凝止血术治疗,比较2组的临床疗效与并发症。结果观察组治疗总效率为93.75%,显著高于对照组的75.00%(P0.05);观察组的住院时间较对照组显著缩短,复发率仅为6.25%,较对照组的31.25%显著降低(P0.05);观察组并发症发生率为37.50%,显著低于对照组的62.50%(P0.05)。结论颌内动脉栓塞术治疗鼻出血合并脑梗死可快速有效止血,疗效优于鼻内镜下鼻腔电凝止血术,术后康复更快,安全性好,值得推广应用。     

应用三丙烯微球对豚鼠子宫肌瘤模型行子宫动脉栓塞的实验

背景：子宫动脉栓塞术作为治疗子宫肌瘤的重要手段已广泛应用于临床,疗效令人满意,但对子宫动脉栓塞术的基础研究目前尚处于起步阶段,理论系统尚不完善。应用新型栓塞剂三丙烯微球行豚鼠子宫肌瘤模型进行子宫动脉栓塞操作的相关文献报道作者尚未查到。 目的：实验设计了以三丙烯微球进行豚鼠子宫肌瘤模型子宫动脉栓塞的可行性验证。 方法：30只成年雌性豚鼠随机分为两组：盆腔动脉铸型组10只,用于行盆腔血管铸型术,了解雌性豚鼠子宫动脉起源、行程、长度、直径及分支等解剖学特征;子宫肌瘤模型动脉栓塞组20只,应用雌孕激素联合法诱导子宫肌瘤模型建立,并行双侧子宫动脉微球栓塞的技术研究及病理分析。 结果与结论：双侧子宫动脉主干由髂内动脉发出,主干和弓状支的血管直径分别为(0.350±0.022) mm及(0.160±0.012) mm。子宫肌瘤模型动脉栓塞组20只豚鼠成功行双侧子宫动脉栓塞术。术中40~120 µm及100~300 µm三丙烯微球的用量分别为(0.040±0.005) mL和(0.017±0.002) mL。子宫肌瘤模型动脉栓塞组肌瘤成模率达75%。病理切片可见子宫动脉弓状支、浆膜下二级分支及部分三级分支动脉内均有栓塞微球存在。子宫肌层增厚,肌瘤结节处细胞呈栅栏状或编织状排列。栓塞后肌瘤缺血坏死明显,子宫肌层及内膜无缺血坏死病理改变。说明应用三丙烯微球行豚鼠子宫肌瘤模型动脉栓塞术具有可行性,栓塞效果良好。 关键词：三丙烯微球;子宫动脉栓塞术;豚鼠;子宫肌瘤;控制释放载体材料 doi:10.3969/j.issn.1673-8225.2010.08.012     

闭塞载瘤动脉与保留载瘤动脉栓塞治疗未破裂大脑后动脉动脉瘤疗效的比较

目的探讨闭塞载瘤动脉与保留载瘤动脉栓塞治疗未破裂大脑后动脉动脉瘤(PCA)的效果。方法回顾性分析2009年1月至2014年1月栓塞治疗的36例PCA的临床资料,其中闭塞载瘤动脉22例(闭塞组),保留载瘤动脉14例(保留组)。结果闭塞组大或巨大动脉瘤比例(77.3%,17/22)明显高于保留组(35.7%,5/14;P0.05)。术后即刻造影显示,闭塞组Raymond分级1级栓塞率(95.5%,21/22)明显高于保留组(64.3%,9/14;P0.05)。两组术后缺血性事件发生率、颅内出血发生率均无统计学差异(P0.05)。术后随访6个月至2年,闭塞组改良Rankin量表(m RS)评分≤2分18例,2分4例;保留组m RS评分≤2分13例,2分1例;两组m RS评分无统计学差异(P0.05)。闭塞组12例、保留组11例接受DSA或CTA随访,其中闭塞组血管再通或复发1例(8.3%);保留组复发或动脉瘤腔仍显影2例(18.2%);两组血管再通率或复发率无统计学差异(P0.05)。结论血管内栓塞治疗未破裂PCA时,根据动脉瘤具体特点选择闭塞载瘤动脉或保留载瘤动脉均是行之有效的方法。     

血管造影栓塞明胶海绵栓塞剂在骨盆骨折大出血中应用20例

解放军第二军医大学长海医院骨科2001-01/2003-08在入院3~8 h内急诊行明胶海绵栓塞剂材料血管造影栓塞治疗骨盆骨折大出血患者20例，男12例，女8例；年龄18~70岁，平均43.4岁。8例将导管超选择性插入病变髂内动脉分支内，用明胶海绵颗粒与对比剂一起注入。12例将导管置于髂内动脉主干用明胶海绵颗粒与对比剂一起注入。全部患者均顺利完成栓塞治疗，栓塞后患者血压逐步回升至正常水平，未出现严重的栓塞并发症。1例于血压稳定后病情恶化死亡。结果提示使用明胶海绵栓塞剂材料血管造影栓塞是骨盆骨折大出血的一种安全、迅速、有效的止血措施。     

改良明胶和羟乙基淀粉130/0.4输注冠状动脉旁路移植患者：麻醉诱导早期扩容效果的比较

摘要 背景：临床迫切需要了解不同类型胶体溶液对于重症患者和麻醉关键时期的扩容效果及寻找适合临床应用的简易评估方法。 目的：测定分析定量液体输入前后血浆胶体渗透压和血红蛋白的动态变化,依据质量守恒原理建立方程估测血管内容量,比较麻醉诱导后羟乙基淀粉130/0.4和琥珀酰明胶的扩容效果。 方法：选择30例择期行冠状动脉旁路移植术的患者,采用常规麻醉及诱导,于诱导后10 min内分别输注7 mL/kg羟乙基淀粉130/0.4或琥珀酰明胶。分别于输注前,输注后即刻,输注后1 h,测量血红蛋白浓度,红细胞压积,胶体渗透压和平均动脉压。而后通过公式计算得出3个时间点的血管内容量(V(0),V(1),V(2)),两个时点的扩张容量(V△1,V△2)和即刻扩容比V△1/V(infusion)等指标。 结果与结论：两组组间比较各时点平均动脉压变化差异无显著性意义(P > 0.05),两组组内比较液体输注后测定容量明显超过输液前,V(1) > V(0)(P < 0.05)。而且两组即刻扩容比 V△1/V(infusion)均大于100%,但组间差异无显著性意义(P > 0.05)。输液1 h后测定容量与输液后即刻(V(2)与V(1))相比,琥珀酰明胶组内差异无显著性意义(P > 0.05),羟乙基淀粉130/0.4组内V(2) > V(1) (P < 0.05)。以上结果说明羟乙基淀粉130/0.4和琥珀酰明胶具有相似的强大的即刻扩容能力,输注后均可实现血管外液体向血管内的转移,但在胶体输注后1 h,羟乙基淀粉130/0.4的容量维持效应稍优于琥珀酰明胶,但无临床显著血流动力学变化差异。 关键词：羟乙基淀粉;琥珀酰明胶;胶体渗透压;容量;麻醉诱导 doi:10.3969/j.issn.1673-8225.2010.21.044     

无氧间歇训练对大鼠骨骼肌、心肌、肝脏自由基代谢的影响

背景：无氧间歇训练法是一种被广泛应用的重要训练方法，有关此训练对机体自由基代谢及其抗氧化酶活性影响的系统性研究较少。 目的：观察无氧间歇训练对大鼠体内自由基代谢的影响。 设计、时间及地点：随机对照动物实验，于2008-03/05在徐州师范大学运动生理实验室完成。 材料：健康雄性SD大鼠32只，体质量230~270 g，随机分为安静对照组，间歇训练对照组，间歇运动即刻组，间歇训练即刻组，每组8只。 方法：安静对照组不进行训练，间歇训练对照组和间歇训练即刻组进行跑步运动，以坡度10°，速度26.8 m/min运动1 min，后以坡度为0，速度5 m/min休息3 min，每天连续20次不间断，5 d/周，运动6周。间歇运动即刻组只在第6周最后一天进行一次运动。 主要观察指标：6周运动结束后即刻麻醉下处死各组大鼠，测定其骨骼肌，心肌，肝脏超氧化物歧化化酶，谷胱甘肽过氧化物酶，过氧化氢酶，丙二醛。 结果：①训练组运动后即刻各组织超氧化物歧化酶活性均显著高于间歇运动即刻组(P < 0.05)。②间歇运动即刻组股四头肌、心肌谷胱甘肽过氧化物酶活性显著低于安静对照组(P < 0.05)，丙二醛含量显著高于安静对照组(P < 0.05)，股四头肌和肝脏过氧化氢酶活性显著高于安静对照组(P < 0.05)。③间歇训练即刻组股四头肌、心肌谷胱甘肽过氧化物酶活性显著高于间歇运动即刻组(P < 0.05)，丙二醛含量明显低于间歇运动即刻组(P < 0.05)，股四头肌和心肌过氧化氢酶活性显著高于间歇运动即刻组(P < 0.05)。 结论：无氧间歇训练可以使机体抗氧化酶活性发生适应性变化，自由基清除能力增强。     

亚甲蓝磁性明胶微球在外磁场作用下对家兔痛阈及体感诱发电位的影响☆

背景：靶向给药系统是一种安全高效的药物传递途径和技术，是一种新的制剂技术和工艺，这种制剂能将药品运送到靶器官或靶细胞，而正常部位几乎不受药物的影响。 目的：实验拟观察亚甲蓝磁性明胶微球在外磁场作用下对家兔痛阈及体感诱发电位的影响，探讨其对脊髓背根神经结靶向神经阻滞的可行性。 设计、时间及地点：随机对照动物实验，于2004-03/2005-04在解放军总医院实验动物中心完成。 材料：雄性新西兰兔24只，体质量2.3~2.8 kg；空白明胶微球（自制）；亚甲蓝磁性明胶微球（自制，载药量为9.8%）。微球系院内药理学实验室高级技师协助制备。 干预：24只家兔随机数字表法分为亚甲蓝磁性微球15 mg 组：在外磁场作用下家兔蛛网膜下腔注射亚甲蓝磁性明胶微球15 mg；空白磁性微球15 mg 组注射单纯磁性微球15 mg；假手术对照组：麻醉和手术步骤同其他组，每组8只。 主要观察指标：连续观察注射药物后家兔下肢的电痛阈、运动功能及脊髓体感诱发电位的变化，最后取脊髓腰骶端作病理切片观察。 结果：24只新西兰兔均进入结果分析。①亚甲蓝磁性微球15 mg 组家兔后肢电痛阈值在给药后第1~6天明显升高，与自身给药前及其他组相比，差异显著（P < 0.05）。②亚甲蓝磁性微球15 mg 组家兔体感诱发电位N1波潜伏期第1~11天明显延长，与自身给药前及其他组相比，差异显著（P < 0.05）；术后13 d 恢复正常。③病理观察显示各组脊髓背角结构、形态正常，神经轴索排列正常，灰白质界限清楚，除假手术对照组外其他组背角均有少数未完全降解的微球，各组的脊髓前角可观察到形态正常的前角运动神经细胞及神经轴索，结构完整。 结论：亚甲蓝磁性明胶微球在外磁场作用下可靶向阻滞脊髓背根神经结，提高家兔的痛阈并延长体感诱发电位，具有“感觉-运动”分离阻滞作用，是一种有效的长效靶向神经阻滞剂。     

两种吸收性止血材料在高血压脑出血手术中的应用

目的探讨2种吸收性止血材料(止血纱布和明胶海绵)在高血压脑出血手术中术腔止血的效果。方法对手术中利用纱布(48例)或明胶海绵(43例)局部术腔贴敷止血的高血压脑出血患者进行回顾性分析。结果止血纱布的止血成功率为98%,术后复查头部CT检查示术腔残余血量体积平均为1.2cm×2.6cm×1cm;明胶海绵的止血成功率为90%,术后复查头部CT检查示术腔残余血量体积平均为2.3cm×3.4cm×1cm。结论可吸收止血纱布组织相容性好,使用方便、安全,术腔残余血量少,并发症少,是高血压脑出血手术局部止血的理想材料。     

Cerebral and systemic infarcts after bronchial artery embolization

Bronchial artery embolization with microspheres constitutes an effective, safe procedure for controlling hemoptysis. A 17-year-old girl with cystic fibrosis developed hemoptysis and underwent bilateral bronchial artery embolization with 300-500 μm and 500-700 μm microsphere particles. Afterward, she was delirious and complained of headache. On initial examination, she manifested altered mental status and diffuse hyperreflexia. Her left fifth digit was painful and cyanotic. Neuroimaging demonstrated multiple embolic infarcts in the cerebellum, thalamus, and cerebral hemispheres. An echocardiogram produced normal results. An evaluation of her thrombophilia revealed heterozygosity for a prothrombin 20210A mutation. Her functional neurologic recovery was complete. To our knowledge, this is the first pediatric case of cerebral and systemic embolism after bronchial artery embolization. Although this complication is not predictable, it should be suspected in patients with underlying chronic lung disease who develop acute neurologic signs after bronchial artery embolization, because these patients are prone to anomalous arterial-arterial shunt formation.     

海藻酸钙凝胶栓塞治疗兔VX2肝种植瘤

背景：液体海藻酸钙凝胶是最近出现的一种新型栓塞材料,具有良好的生物相容性,可经微导管输送,不易形成异位栓塞等特点,在动静脉畸形和动脉瘤动物实验中效果良好。 目的：为了寻找更安全有效的肝癌栓塞材料,创新性使用液体海藻酸钙凝胶肝动脉栓塞兔VX2肝种植瘤。 方法：采用改良开腹接种法建立VX2肝种植瘤模型。以数字表法随机分为对照组、实验组。直视下细针穿刺肝动脉造影,对照组仅行肝动脉造影,实验组造影后使用液体海藻酸钙凝胶栓塞治疗。于栓塞治疗前、治疗后7d行肝脏CT扫描,多平面重建测量肿瘤大小。栓塞治疗7d后取肿瘤行病理组织学检查,评估海藻酸钙凝胶栓塞对肿瘤和正常肝组织的影响。 结果与结论：使用液体海藻酸钙凝胶栓塞后造影显示肿瘤的供血动脉中断,闭塞。实验组兔肝肿瘤生长率明显低于对照组 (P < 0.05)。对照组肿瘤坏死以轻度坏死为主;实验组肿瘤坏死以重度坏死为主,肝可见多发灶状坏死。两组间坏死程度差异有显著性意义(P < 0.05)。实验组甲苯胺蓝染色可见肝动脉分支、叶间小动脉,入肝微动脉完全闭塞,肝窦内有少量海藻酸钙凝胶。结果说明海藻酸钙凝胶可在肝肿瘤血管门部至入肝微动脉间形成广泛栓塞,阻断肿瘤的血供,抑制肿瘤的生长。     

Delirium due to Brain Microembolism: Diagnostic Value of Diffusion-Weighted MRI

Delirum is a common complication in hospitalized patients and it is characterized by acute disturbances of consciousness, attention, cognition, and perception. Despite the frequency with which it is observed, ischemic stroke is generally considered as an unusual cause of delirium. A subtype of brain embolism is characterized by multiple small emboli in different vascular territories, a condition known as "brain microembolism." Given the high contrast of acute ischemic lesions in diffusion weighted imaging (DWI) this technique is particularly helpful to detect these small infarctions. We present here a patient with pulmonary metastases who was treated with bronchial artery embolization and who subsequently developed delirium due to brain microembolism. The embolic material crossed through pulmonary arteriovenous fistulas, producing multiple areas of cerebral ischemia. The ischemic lesions could be visualized only on DWI, and they affected the periventricular region, caudate nucleus, thalamus, and cerebellum.     

罂粟碱明胶微球治疗脑血管痉挛的实验研究

目的 研制罂粟碱明胶微球，探索微球药物控释系统治疗脑血管痉挛的可行性。方法 采用改良的双相乳化冷凝聚合法制备明胶微球。并将其与盐酸罂粟碱复合。观察微球分散度、粒径及外观形态；计算微球包封率、载药率及体外释药特性。将自体动脉血分二次注入枕大池制备兔蛛网膜下腔出血（SAH）模型，随后将罂粟碱明胶微球注入该模型兔的枕大池；第7天时，观察并计算基底动脉血管横截面积。结果 微球大小均匀，平均直径（18．36±3．56）μm，载药量为28．0％，包封率为93-3％，体外14d内药物缓释91．0％。兔的基底动脉横截面积：正常组为（0．91±0．19）mm^2，SAH模型组为（0.3l±0．44）mm^2，明胶微球（不含罂粟碱）组为（0．21±0．05）mm^2，罂粟碱明胶微球组为（0．71±0．11）mm^2；罂粟碱明胶微球与SAH模型组和明胶微球组间有明显差异（P〈0．05）。结论 在蛛网膜下腔早期注入罂粟碱缓释明胶微球对实验性脑血管痉挛有防治作用。     

机械取栓治疗兔急性栓塞性脑梗死的实验研究

目的探讨机械取栓治疗兔急性栓塞性脑梗死的效果。方法将30只新西兰大白兔应用血流阻断加注射凝血酶方法制作兔右颈总动脉栓塞模型,然后将其随机分为取栓组、溶栓组和对照组,每组10只。造模成功后3h,取栓组行机械取栓治疗,溶栓组应用重组组织型纤溶酶原激活剂行动脉内溶栓治疗,对照组不治疗。取、溶栓前后行DSA了解血管再通情况;比较取、溶栓前后大脑中动脉流速（Vmca）及各组栓塞后3、6、8、12、24h磁共振弥散系数（ADC）值的差异;比较各组24h神经功能评分。结果取栓组和溶栓组血管再通率分别是80％和20％,差异有统计学意义（P〈0．05）。取栓组和溶栓组治疗后Vmca显著增快（P〈0．05）,取栓组增加更显著（P〈0．05）。取栓组和溶栓组24hADC值、神经功能评分较治疗前显著改善（P〈0．05）,取栓组改善更显著（P〈0．05）。结论取栓治疗急性栓塞性脑梗死安全、有效,疗效优于血管内溶栓治疗。     

Comparison of Tenecteplase with Alteplase on clinical rating scores following small clot embolic strokes in rabbits

Tenecteplase (TNK) was engineered to have increased fibrin specificity and an increased half-life compared to Alteplase. Although Tenecteplase is currently being tested in a Phase II clinical trial in acute ischemic stroke patients, little is known about the pharmacology and dose-response or therapeutic window for Tenecteplase in embolic stroke models. In the present study, we compared Tenecteplase with Alteplase on behavioral outcome in rabbits with embolic strokes. Male New Zealand white rabbits were embolized by injecting a suspension of small blood clots into the middle cerebral artery (MCA) via a catheter. The rabbit small clot embolic stroke model (RSCEM) was used for a dose-response profile analysis of Tenecteplase (0.1 mg/kg-3.3 mg/kg) and Alteplase (0.9 mg/kg-3.3 mg/kg) given intravenously 1 h following embolization. In additional studies, Tenecteplase (0.9 mg/kg) or Alteplase (3.3 mg/kg) was administered 3 (or 6) h following embolization to determine the therapeutic window for the thrombolytics. For both studies, behavioral analysis was conducted 24 h following embolization, allowing for the determination of the effective stroke dose (P50) or clot amount (mg) that produces neurological deficits in 50% of the rabbits. Using the RSCEM, a drug is considered beneficial if it significantly increases the P50 compared with the control group. The P50 of controls 24 h after embolization was 1.13 +/- 0.15 mg. Rabbits treated 1 h post-embolization with Tenecteplase (0.1, 0.25, 0.9, 1.5 or 3.3 mg/kg) had P50 values of 1.48 +/- 0.33, 2.20 +/- 0.44, 2.76 +/- 0.37, 2.15 +/- 0.29 and 2.78 +/- 0.31 mg, respectively. In Alteplase-treated rabbits, only the 3.3 mg/kg dose significantly increased the group P50 by 189% compared to control. Tenecteplase was also effective at increasing the P50 value to 2.21 +/- 0.43 mg if there was a 3-h delay following embolization, but not if there was a 6-h delay before administration. Alteplase was only effective if administered 1 h following embolization where it significantly increased the P50 value to 3.27 +/- 0.40 mg. This study indicates that Tenecteplase has a wide therapeutic range, a therapeutic window of at least 3 h and a durable effect. Moreover, the safety profile for Tenecteplase is similar to that of Alteplase. Tenecteplase does not increase the rate of intracerebral hemorrhage (ICH) above that produced by Alteplase. However, the therapeutic range and window for Alteplase is more limited than that for Tenecteplase. Our preclinical studies suggest that Tenecteplase has a better pharmacological profile than Alteplase and supports further investigation of Tenecteplase in randomized double-blinded clinical trials in stroke patients.     

Clinical application of asymptomatic embolic signal detection in acute stroke: a prospective study.

BACKGROUND AND PURPOSE: The detection of asymptomatic embolization with the use of Doppler ultrasound has a number of potential applications in patients with acute stroke. It may provide information on the stroke pathogenesis in individual cases, identify patients with continued embolization, and allow localization of the active embolic source. METHODS: We recruited 119 patients with acute anterior circulation infarction within 72 hours of stroke onset. Transcranial Doppler recordings were possible in 100 (84.0%). Bilateral 1-hour middle cerebral artery (MCA) recordings were made and saved on digital audiotape for blinded offline analysis. When embolic signals were detected during screening of the first recording, simultaneous recording was performed from the ipsilateral MCA and common carotid artery for an additional 30 minutes. In all patients with embolic signals at screening and in matched negative controls, recordings were repeated on days 4, 7, and 14. RESULTS: Embolic signals were detected in the symptomatic MCA in 16 patients (16%). They were more common in patients with carotid stenosis (P<0.0001), occurring in 50% of this group. They were rare in patients with cardioembolic stroke (4.5%) and were not detected in patients with lacunar stroke. In the 16 patients with embolic signals, the proportion with embolic signals fell over time (P=0. 0025), but they were still present in a third at 2 weeks. In 10 patients, localization of the embolic source was possible by simultaneous recording from the MCA and the ipsilateral common carotid artery. CONCLUSIONS: Continued asymptomatic embolization is common after stroke in patients with carotid artery disease and is still present in a significant proportion at 2 weeks. The technique may identify patients at risk of further stroke for more aggressive antiplatelet therapy; this needs to be tested in large prospective studies. The technique may also allow localization of the active embolic source.     

Hydro<Emphasis Type="Italic">Coil</Emphasis> embolization of a ruptured infectious aneurysm in a pediatric patient: case report and review of the literature

Introduction Intracranial infectious aneurysms in the pediatric population are rare. Although surgery has been the traditional treatment of ruptured pediatric infectious aneurysms, endovascular coil embolization has become an attractive alternative due to its low rate of morbidity and mortality. Case report A 9-year-old boy with a significant medical history of aortic valve replacement, antibiotic-treated infective endocarditis, and multiple embolic cerebral infarcts presented with a high-grade intraventricular hemorrhage due to the rupture of a large infectious proximal posterior circulation aneurysm. Computed tomography and cerebral angiogram demonstrated a right crural/ambient cistern hematoma and an associated infectious aneurysm of the right proximal posterior cerebral artery. The ruptured infectious aneurysm was coil-embolized with hydrogel-coated platinum coils without sacrifice of the distal parent artery. The aneurysm was completely occluded, and the patient regained all neurological function. Conclusion Ruptured infectious aneurysms in the pediatric population occur despite aggressive medical therapy. Patients with infective endocarditis and embolic infarcts should be followed closely due to the risk of major hemorrhagic events, including aneurysm rupture. Hybrid coil embolization of ruptured infectious aneurysms with preservation of the distal parent artery is exceedingly rare and effective in the management of ruptured infectious aneurysms in the pediatric population.     

不同介入方法治疗颅内大型或巨大型动脉瘤的单中心经验

目的 评价不同介入方法治疗颅内大型或巨大型动脉瘤的有效性、并发症发生率以及预后情况。 方法 回顾性分析第二军医大学附属长海医院神经外科自2001年1月～2010年12月采用不同介入方法治疗的134例颅内大型或巨大型动脉瘤患者的临床资料,按患者接受介入治疗方法不同分为4组,其中载瘤动脉闭塞术11例,单纯弹簧圈栓塞20例,支架辅助下弹簧圈栓塞78例,血流导向装置治疗25例,随访时间6～44个月。影像学结果依据改良Raymond评分,临床症状依据改良Rankin量表（modified Rankin Scale,mRS）评分系统评价,分别评价4组患者出院时的预后良好率、末次随访时动脉瘤的治愈率、复发率,预后良好率及手术并发症情况。 结果 载瘤动脉闭塞组出院时的预后良好率是100%,单纯弹簧圈栓塞组为70%,支架辅助弹簧圈组为91%,而血流导向装置组为100%,四组间差异具有显著性（P=0.0030）。载瘤动脉闭塞组末次随访时治愈率是63.6%,单纯弹簧圈栓塞组为5.6%,支架辅助弹簧圈组为37.2%,而血流导向装置组为72%,四组间差异具有显著性（P=0.0002）。载瘤动脉闭塞组末次随访时的复发率为0%,单纯弹簧圈栓塞组为83.3%,支架辅助弹簧圈组为30.8%,而血流导向装置组为0%,四组间差异具有显著性（P＜0.0001）。载瘤动脉闭塞组末次随访时预后良好率为100%,单纯弹簧圈组为75%,支架辅助弹簧圈组为90%,血流导向装置组为100%,四组间差异具有显著性（P=0.0209）。载瘤动脉闭塞组并发症发生率为27.3%,单纯弹簧圈组为30%,支架辅助弹簧圈组为14.1%,血流导向装置组为0%,四组间差异无显著性（P=0.0650）。 结论 在颅内大型或巨大型动脉瘤的介入治疗中,单纯弹簧圈栓塞复发率高,支架辅助弹簧圈栓塞可降低复发率,载瘤动脉闭塞组预后良好率及复发率满意,但并发症发生率偏高,血流导向装置的初步临床结果令人满意。