2016年 · 第96卷第27期

Takayasu artertis (TA) is a systemic granulomatous macrovasculitis of unknown etiology that mainly involves the aorta and its branches. It occurs in Asian women under 40 years old. Blood vessels such as aorta, aortic arch and unnamed artery above arch, left common carotid artery, left subclavian artery, ascending aorta, thoracic and abdominal aorta, renal artery and pulmonary artery are often involved. Stenosis, occlusion or dilation of blood vessels leads to ischemia, infarction or bleeding of the affected organs, which ultimately leads to organ failure, blindness, syncope, hemiplegia, coma, renal failure and other manifestations, which threaten patients' lives in severe cases. The difficulty of diagnosis and treatment of Takayasu arteritis lies in the fact that most patients have a hidden onset and progress quietly. Once symptomatic, vascular disease is not early and often irreversible. Therefore, this leads to poor prognosis and low quality of life of Takayasu arteritis patients. On the other hand, there is not enough attention to Takayasu arteritis worldwide. From the 1950s to now, the number of literatures per year is less than 100, and most of them are reviews or surgical case reports of vascular lesions. So far, the pathogenesis of this disease is unknown, and there is a lack of clinical diagnosis and therapeutic research in a large sample size. Therefore, this also leads to the lack of diagnosis and evaluation methods of Takayasu arteritis, and the treatment is mostly based on clinical experience. In recent years, the development of diagnostic technology, the emphasis on clinical research and the promotion of precision medicine have brought opportunities for the progress of diagnosis and treatment of Takayasu arteritis.

Most of the various disciplines of clinical medicine are divided according to systems or organs, and there are many correspondences between internal medicine and surgery, such as thoracic surgery and respiratory surgery, cardiac surgery and cardiology, gastrointestinal surgery, hepatobiliary surgery, pancreatic surgery, anorectal surgery, etc. also echo with gastroenterology. Those with indications for surgery were returned to surgery, and those without indications for surgery were returned to internal medicine. In many cases, the disease requires medical and surgical cooperation, especially those who have elective surgery. It is often necessary to control the disease activity first to create conditions for surgery, and long-term medical treatment is needed after surgery to prevent recurrence. The cooperation of internal medicine and surgery can often obtain better results. Some specialties of a surgical nature were once confused because there was no corresponding internal medicine, and orthopedics is an example. In the 1980s, orthopedic experts from Xiangya Hospital affiliated to Central South University once called for the establishment of "orthopedic medicine", but it was unrealistic for surgeons to switch to internal medicine. Later, with the establishment of the Department of Rheumatology and Immunology, orthopedic surgeons found "Orthopedics" here. In recent ten years, biomedical engineering has promoted the development of artificial blood vessels, vascular stent intervention and other technologies, and vascular surgery has grown rapidly. Does vascular surgery need to have a corresponding "vascular medicine"?

neurodegeneration with brain iron accumulation (NBIA) is a group of rare neurogenetic degenerative diseases caused by gene mutation with extrapyramidal symptoms and other complex clinical symptoms. Abnormal iron deposition can be seen in specific parts of brain tissue. The incidence is (1~3) /1 000 000. Despite the high clinical and genetic heterogeneity of the NBIA disease spectrum, such diseases have characteristic abnormal signs on imaging, especially magnetic resonance (MRI), due to abnormal deposition of iron ions. Molecular genetics testing of the disease-causing gene can confirm the diagnosis. In order to help clinicians more accurately diagnose and standardize the treatment of NBIA disease spectrum, an expert consensus on the diagnosis and treatment of neurodegenerative diseases with iron deposition in brain tissue has been specially formulated.

A 37-year-old female was admitted to Taizhou People's Hospital of Jiangsu Province with abdominal pain for 1 d. The patient had abdominal pain without obvious trigger, progressive aggravation, vomiting twice, abdominal distension, previous history of cesarean section and ectopic pregnancy, slight tension in the abdominal wall during physical examination, tenderness in the whole abdomen, mainly in the lower abdomen, positive mobile voicing, and normal intestinal sounds. Laboratory tests: blood amylase 31 U/L, hemoglobin 95 g/L. Transabdominal B-ultrasound of uterine adnexes showed mixed echoes of 8.2 cm ×3.1 cm in the posterior pelvic cavity of the uterus, and the internal echoes were messy (Figure 1)。 Emergency total abdominal CT plain scan + enhancement showed a large amount of blood and fluid accumulation in the abdominal and pelvic cavities, full uterine shape, multiple tortuous enhanced vascular shadows around the uterine body, 3 cm ×2 cm mass-shaped annular enhancement shadows in the right uterine corner, no obvious contrast medium exudation shadows, and annular enhancement shadows in the right adnexal area (Figure 2)。 Emergency urinary pregnancy test was positive with chorionic gonadotropin>10 000 IU/L. Emergency laparoscopic abdominopelvic exploration: 1 000 ml of abdominopelvic hemorrhage and clotting, full uterus, absence of right fallopian tube, a 3 cm ×2 cm ×2 cm protrusion formed in the right uterine horn and the stump of the right fallopian tube interstitium, with a purple-black surface, a rupture and active bleeding were seen, the interstitial part of the fallopian tube was incised to the horn of the uterus, about 3 cm long, and villus was extruded. Intraoperative diagnosis: rupture of pregnancy of the fallopian tube stump. Pathological results: A small amount of basal decidua, villi and trophoblast cells were found in the right uterine horn clot, and local trophoblast cell proliferation stage.

perioperative visual loss (POLV) can occur during or after non-eye surgery. This phenomenon is very rare, but once it occurs, it will bring disastrous consequences for both doctors and patients. Non-eye surgery POLV is a ghost that quietly arrives with the development of surgery and anesthesiology. It was first developed by Slocum et al.^[1]It was reported in 1948 and later reported in various surgical fields. Based on some physicians' sense of self-protection or fear of causing disputes, the number of reported cases of non-eye surgery POLV should be much smaller than the true number of cases. In recent years, with the gradual increase of the number of cases, this phenomenon has gradually attracted people's attention. The American Society of Anesthesiologists (ASA) established a POLV registry in 1999, developed a POLV patient manual, recommended that patients be fully informed about POLV before surgery, and conducted relevant research^[2]。

Takayasu arteritis is an immune-related chronic non-specific, granulomatous macrovascular vasculitis that mostly occurs in young women and is common in Southeast Asian countries such as China, Japan and India, and Turkey in the Middle East. Takayasu arteritis progresses latently, mainly involving the aorta and subclavian artery, common carotid artery, renal artery and other branch arteries. Chronic vascular fibrosis leads to wall thickening, lumen stenosis, ischemia and functional impairment of corresponding organs. Patients can show systemic symptoms such as fever, fatigue, and weight loss, as well as symptoms or signs of vascular involvement such as hypertension, pulselessness, vascular murmur, and dizziness. Since Japanese scholars reported the disease in 1908, Takayasu arteritis has been reported all over the world. At present, with the improvement of imaging technology, the diagnosis rate of Takayasu arteritis has also increased. However, the research of Takayasu arteritis is obviously lagging behind in the field of rheumatism, and most of them are case reports, case analysis and cross-sectional studies. In recent years, foreign basic and clinical research on Takayasu arteritis has made progress, including serological markers of the disease, disease assessment system and treatment plan, etc. However, there is no systematic basic and clinical research on Takayasu arteritis in China, and due to regional and ethnic differences, the diagnosis, assessment system and treatment plan of Takayasu arteritis proposed abroad need to be verified in the Chinese population before they can be applied and popularized in clinical practice. The progress in the diagnosis, disease assessment and treatment of Takayasu arteritis is summarized as follows.

computer tomography perfusion imaging (CTPI) is a technique developed based on the principle of calculating organ blood flow in nuclear medicine. It can reflect the hemodynamic state of tissues and organs, and belongs to the category of functional imaging. The quantitative study of perfusion parameters of liver is helpful to detect the hemodynamic changes of liver lesions before the morphology changes, and has a wide clinical application prospect. This article reviews the characteristics of liver CTPI and its value in evaluating the biological characteristics and therapeutic efficacy of hepatocellular carcinoma.