供者淋巴细胞输注治疗慢粒急淋变异基因造血干细胞移植后复发1例

患者,男,36岁。于2005-04发现两侧颈部、下颌下淋巴结肿大,伴低热、乏力,疑诊“淋巴结炎”,先后输“青霉素、先锋霉素”治疗2月余,肿大之淋巴结无缩小。于2005-06-13入我院。查体:轻度贫血貌,颈两侧和腹股沟可触及数个蚕豆大小的淋巴结,胸骨压痛(+),心肺(-),肝肋下未触及,脾肋缘下6 cm,触痛(+)。实验室检查:WBC 224.2×109/L,Hb 81 g/L,PLT 211.2×109/L。骨髓检查:有核细胞增生极度活跃,粒细胞占0.94,以中、晚幼粒细胞为主,嗜酸、嗜碱细胞比例略高。染色体检测:Ph+率92%。诊断慢性粒细胞性白血病(CML),慢性期。给予羟基脲、小剂量高…     

幼淋巴细胞白血病转淋巴瘤细胞白血病1例

<正>病人,男,67岁。发热5 d,服罗红霉素3 d,未见好转。查体:淋巴结无肿大,肝脾肋下未触及。血常规:WBC 98.6×109/L,Hb 148 g/L,BPC 160×109/L。血涂片分类:原始淋巴细胞2%,幼淋巴细胞23%,淋巴细胞35%,分叶粒细胞40%。骨髓涂片检查:骨髓增生明显活跃,原始淋巴细胞3%,幼稚淋巴细胞69%,形态特点:细胞体积较大,呈圆     

克感敏诱发自身免疫性溶血性贫血1例

1案例报告患者女性,18岁,咳嗽、发热20余天,头晕、乏力、恶心、呕吐1天入院。入院前曾因感冒服用克感敏、头痛酚。查体:重度贫血貌,手、面部皮肤苍白,无酱油色尿。体表淋巴结不肿大,全身皮肤粘膜无出血,肝肋下5cm可及,脾肋下未触及。WBC:19.1×109/L,RBC:0.65×1012/L,HGB:22G/L,PLT:573×109/L。骨髓穿刺检查:有核细胞增生明显活跃,粒系淋巴系增生活跃,细胞形态及阶段比例正常。红系增生明显活跃,以中、晚幼红细胞为主,可见红细胞碎片。巨核系增生活跃,成堆血小板可见,未见寄生虫。铁染色:外铁+,铁粒幼红细胞45%。血片分类:幼稚红细…     

肝硬化并低血糖昏迷误诊为肝昏迷1例

病人 ,男 ,67岁 ,乏力、纳差、腹胀 5年 ,病情加重伴双下肢浮肿 2月。查体 :神志清 ,对答切题 ,面色晦暗 ,皮肤黝黑 ,巩膜中度黄染。颈、胸部多个蜘蛛痣 ,有肝掌。心肺无异常 ,腹隆 ,腹壁静脉曲张 ,肝肋下未扪及 ,脾肋下 5 cm,腹水征 (+)。双下肢中度凹陷性浮肿。实验室检查 :血 WBC5 .4× 1 0 9/L、分类中性 0 .71、淋巴 0 .2 7、嗜酸性粒细胞 0 .0 2 ,血小板 96× 1 0 9/L;总胆红素 3 7.5 mmol/L,ALT1 3 4U/L、白蛋白 2 8g/L、球蛋白 3 6g/L;血糖 4.3 mmol/L,HB-s Ag(+) ,HBe Ag(+)。B超示肝硬化失代偿期征象、脾大、大量腹水。…     

空肠平滑肌肉瘤伴肠套叠并肝转移一例

病例资料 患者,男66岁。因上腹不适,纳差,黑便2个月入院。查体:腹部平坦,未见胃肠型蠕动波,无腹壁静脉曲张,肝脾肋下未及。实验室检查:HGB86g/1,RBC 3.53 ×1012/1,WBC 11.6×109/1。     

脾动脉血管硬化剂栓塞治疗脾功能亢进

目的评价应用血管硬化剂行部分性脾栓塞治疗脾功能亢进的疗效及安全性。方法17例肝硬化脾功能亢进患者,使用微导管行脾脏中下极动脉分支超选择插管硬化剂栓塞。硬化剂包括鱼肝油酸钠和无水乙醇。栓塞体积40%~70%。结果术后2~4周白细胞平均值自(25±12)×109/L[(08~42)×109/L]增至(57±17)×109/L[(37~84)×109/L],t=6257,P<0001;血小板平均值自(34±14)×109/L[(14~61)×109/L]增至(108±48)×109/L[(58~210)×109/L],t=7028,P<0001。无严重的术后不良反应或并发症。结论脾中下极动脉硬化剂栓塞治疗脾功能亢进安全、有效,不良反应轻,同时具有操作简便和相对经济的优点。     

脏原发性淋巴瘤1例

患者,男,48岁.低热,夜间盗汗3个月,无咳嗽、咳痰. 体检:T36.5℃,P80次/min,BP14/10kPa,R20次/min.皮肤巩膜无黄染,浅表淋巴结未及,心肺(-),腹平软,无压痛,未及肿块,肝脾肋下未触及,双肾区叩击痛(-)脊柱四肢正常,神经系统(-). 化验:红细胞4.75×1012/l,白细胞6.6×109/l,中性70%,淋巴30%,血小板124×109/l,血红蛋白116g/l. B超:脾实质内见多个形态不一、大小不等约1.2cm× 0.9cm～3.3cm×2.0cm实质性低回声团块,其内部呈不均质低回声状,境界尚清,后腹膜见一肿大淋巴结.考虑脾内占位性病变伴后腹膜淋巴结肿大.     

急性胰腺炎并发脾静脉栓塞及巨脾一例

病例资料患者,女,42岁,因渐进性腹痛2个月,持续性上腹伴腰周疼痛4d入院。入院时体温38.4℃,血常规:WBC16×109/l,RBC3.2×1012/l,Hb105g/l,PLT310×109/l,血淀粉酶17.2U/l,尿淀粉酶1230U/l,血Ca2+及血糖正常。查体:精神差,表情痛苦,心肺未见异常,腹平坦,未见腹壁静脉曲张,剑突下压痛,无肌紧张,无反跳痛,肝不大,脾大,肋缘下12cm,最远点距肋缘下15cm,向右超过腹正中线1cm,边缘锐利,质地中等硬,触痛,表面不平,移动性浊音(-)。初步诊断:急性胰腺炎;脾大待诊?抑制胰酶分泌,抗炎,支持治疗,3d后腰痛稍减轻,体温恢复正常,脾脏无明显缩小。CT平…     

组织荚膜胞浆菌感染1例报告

病例　男 ,19岁 ,不规则发热伴间断性鼻出血 6月住院。体检 :体温 38.5℃ ,脉搏 10 0次 /min ,呼吸 2 0次 /min ,血压 13/ 7kPa ,消瘦 ,贫血貌 ,浅表淋巴结无肿大 ,皮肤粘膜无黄染 ,心肺末见异常 ,右上腹膨隆 ,轻压痛 ,肝肋下4cm ,脾肋下 6cm ,肾区无叩击痛 ,移动性浊音阴性。血常规 :白细胞 3.8× 10 9/L ,中性粒细胞 0 .70 ,淋巴细胞 0 .2 0 ,红细胞 2 .33× 10 12 /L ,血红蛋白 6 6g/L。腹部B超提示 :肝脾肿大。骨髓穿刺髓片查到组织英膜脑浆菌。经氟康唑治疗 6 0d ,血红蛋白升至 10 .5g/L ,复查腹部B超肝脾正常 ,治愈出院。随访 1年 …     

乙型肝炎并发急性非淋巴细胞白血病1例

患者,男,25岁,乙肝病史13年,间歇乏力,纳差加重伴腹胀1月入院。病程中有发冷发热、全身骨痛、牙龈出血及脱发症。查体:T39.0℃,P112/min,R18/min,BP108/80mmHg;精神差,可见散在出血点,左耳(颈)部及腹股沟可触及肿大的淋巴结,巩膜轻度黄染,肝未及,脾大肋下5.0cm,边钝、质硬,肝区有叩痛。血:WBC74.2×109/L,RBC2.66×1012/L,HGB84g/L,PLT20×109/L,N0.172,L0.72,M0.018,血片中幼稚细胞占97%;POX强阳性;骨髓像:增生极度活跃,粒系原粒+早粒占88%,大部分细胞体积大小一致,核圆形、染色质疏松,可见1～2个核仁,细胞浆量较少染灰蓝色,易…     

Brachial Artery Access for Percutaneous Renal Artery Interventions

Purpose: To evaluate the suitability of transbrachial access for endovascular renal artery interventions. Methods: During 37 consecutive endovascular renal artery interventions, the transbrachial approach was used on nine patients (mean age 63 years; range 41–76 years) for 11 renal artery procedures on native kidneys and one percutaneous transluminal angioplasty (PTA) on a transplanted kidney. The reason for using transbrachial access was a steep aorta-renal angle in five, and severe aorta-iliac atherosclerosis in the remaining patients. In addition to the intervention catheter in the left brachial artery, an additional nonselective catheter for controlling the procedure was inserted transfemorally (six patients) or via the contralateral brachial artery. Results: Eleven interventions (six PTAs, five stents) were successfully completed. The one failure resulted from impenetrable subclavian artery stenosis. The only major complication was a brachial artery pseudoaneurysm requiring surgical treatment. Conclusion: Transbrachial access is an effective and relatively safe technique for renal artery interventions when transfemoral access is not possible. Received: 0/00/00/Accepted: 0/00/00     

Traumatic Axillary Artery Dissection with Radial Artery Embolism

This report describes a case of pathologically proven traumatic arterial dissection, presenting as complete occlusion of the axillary artery with radial artery embolism. Occlusion of the axillary artery by traumatic dissection mimicked transection and radial artery embolism mimicked congenital absence of the radial artery on the initial angiogram, but these were correctly diagnosed with the following sonogram.     

Prostatic Artery Perfusion from the Medial Circumflex Femoral Artery

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Combined Antegrade Femoral Artery and Retrograde Popliteal Artery Recanalization for Chronic Occlusions of the Superficial Femoral Artery

PurposeTo evaluate the efficacy and safety of a dual femoral–popliteal approach in the supine position after failed antegrade recanalization attempts in chronic total occlusion (CTO) of the superficial femoral artery (SFA).Materials and MethodsFrom May 2011 to October 2012, 21 patients underwent dual femoral–popliteal recanalization for CTO of the SFA, with a mean lesion length of 87.4 mm ± 5.8. When contralateral antegrade recanalization of SFA occlusions via the common femoral artery could not be achieved, the occlusions were intrainterventionally accessed by retrograde approach via the popliteal artery, which was punctured anteriorly with gently flexed knee and crus extorsion. When the SFA had been recanalized, further angioplasty and stent placement procedures were completed via the femoral artery.ResultsA technical success rate of 100% (entailing puncture of the popliteal artery and SFA recanalization) was achieved, and no hemorrhage, hematoma, pseudoaneurysm, arteriovenous fistula, or other complications developed. During a mean follow-up of 9.8 months ± 1.5, claudication severity, rest pain, and toe ulcers improved significantly. The pulse of the distal arteries, as well as the filling of the veins, could be distinctly felt. Ankle-brachial index changed from 0.48 ± 0.17 to 0.84 ± 0.11 at 1 year after intervention (P < .001), and patency rates at 1, 6, and 12 months after interventions were 100%, 80%, and 42%, respectively.ConclusionsA dual femoral–popliteal approach in the supine position is an alternative backup option after failed attempts at the antegrade approach for patients with proximal barriers in CTO or lesions with major extending collateral vessels.     

冠状动脉瘤合并肺动脉瘘1例报告

患者　男 ,66岁。胸闷、气短 ,间断发作 9年 ,症状逐渐加重 ,伴气短及胸前区压榨感 ,按冠心病、心绞痛治疗后症状缓解。彩色多普勒显示左心室功能下降。冠状动脉造影显示左主干管状扩张 ,左前降支发出对角支之后形成囊样改变 (图 1)。SCT三维血管成像显示肺动脉圆锥左前方大小约 18mm的类圆形瘤样扩张影 (图 2 ) ,瘤体与左冠状动脉前降支之间可见大量迂曲成团的动脉血管影 ,紧贴肺动脉干分布 ,并与左前降支相连 (图 3 )。瘤体与冠状动脉根部有一细小血管影 ,该血管末端直径约 1.3mm ,其右 (外 )侧有一较粗大右冠状动脉血管 ,可见与瘤体交…     

左冠状动脉异常起源于肺动脉1例报告

冠状动脉起源于肺动脉是一种较为罕见的先天性心血管异常,约占先天性心脏病的0 .2 6%～0 .5 % [1] 。我院最近遇到1例,资料较完整,报道如下。1　病例报告患者,女,14岁。发现心脏杂音2 0d入院。自幼有活动后心悸、气短,无法完成重体力劳动,偶有头晕。体检发现胸骨左缘第三肋间收     

正常肺动脉和肺动脉高压的磁共振成像研究

目的　确定MRI评价正常肺动脉和肺动脉高压 (PAH)病因及其顺应性变化的价值。材料与方法　在GEVectra 0 .5T超导MR仪上采用肺动脉长轴对正常组 ( 2 3例 ,年龄 10～ 79岁 )和PAH组 ( 2 1例 ,年龄 2～ 66岁 )进行SE和CineMRI检查 ,以测量其管径和顺应性改变 ,并辅以其他成像平面以确定PAH的病因。结果　正常组采用SE测量的管径值为 :肺动脉主干 (MPA) 2 .5 4cm±0 .2 3cm、右肺动脉 (RPA) 1.74cm± 0 .2 3cm、左肺动脉 (LPA) 1.77cm± 0 .2 9cm ,采用CineMRI测得的顺应性为 :MPA 12 %、RPA 16%、LPA13 % ;18例经心导管、造影和 /或手术证实有PAH者MRI均很好显示出其原发病变 ,2例慢性阻塞性肺部疾病 (COPD)和 1例原发PAH者MRI也显示中央肺动脉显著扩张和右室肥厚。经测量PAH组MPA、RPA和LPA管径较正常组增宽明显 ,其顺应性下降显著 ,经t检验 ,两组差异具有非常显著意义 (P <0 .0 0 1)。结论　MRI对确定PAH产生的原因及其顺应性变化具有重要价值     

左冠状动脉起源于肺动脉1例报告

病人　女 ,14岁。发现心脏杂音 8年 ,体检 :心前区触及震颤 ,胸骨左缘 3～ 5肋间闻及 / 6级较粗糙收缩期吹风样杂音 ,主动脉瓣区 / 6级舒张期杂音。临床及彩色多普勒均疑有右冠状动脉右室瘘。X线检查 :胸片示左室增大。右冠状动脉造影示右冠状动脉主干粗大 ,其分支迂曲增粗 ,并形成丰富的血管网 ,继而逆向充盈左冠状动脉、肺动脉干 (附图 )。手术证实左冠状动脉发自肺动脉干近肺动脉瓣之后外侧 ,遂将其移植到主动脉左冠窦处 ,术后效果良好。讨论 :冠状动脉异位起源罕见。多为左冠状动脉起自肺动脉 ,病人多因心肌缺血而于幼年死亡。个别病…