Manejo perioperatorio y periprocedimiento del tratamiento antitrombótico: documento de consenso de SEC,SEDAR, SEACV,SECTCV, AEC,SECPRE, SEPD,SEGO, SEHH,SETH, SEMERGEN,SEMFYC, SEMG,SEMICYUC, SEMI,SEMES, SEPAR,SENEC, SEO,SEPA, SERVEI,SECOT y AEU

During the last few years, the number of patients receiving anticoagulant and antiplatelet therapy has increased worldwide. Since this is a chronic treatment, patients receiving it can be expected to need some kind of surgery or intervention during their lifetime that may require treatment discontinuation. The decision to withdraw antithrombotic therapy depends on the patient's thrombotic risk versus hemorrhagic risk. Assessment of both factors will show the precise management of anticoagulant and antiplatelet therapy in these scenarios. The aim of this consensus document, coordinated by the Cardiovascular Thrombosis Working Group of the Spanish Society of Cardiology, and endorsed by most of the Spanish scientific societies of clinical specialities that may play a role in the patient-health care process during the perioperative or periprocedural period, is to recommend some simple and practical guidelines with a view to homogenizing daily clinical practice.Full English text available from: www.revespcardiol.org/en     

腹痛,腹泻,便血,脱发,指甲萎缩,胃肠息肉

患者女,67岁。2个月前始,无明显原因及诱因出现上腹及脐周痛,伴腹胀、纳差,腹泻与便秘交替出现。胃镜检查发现胃粘膜皱襞粗大,呈脑回状,胃体前壁及大弯侧可见弥漫性息肉样粘膜增生、糜烂。大便OB(++)。按“糜烂性胃炎”口服洛赛克、西沙必利等10天,症状无好转。近半月,患者腹痛、腹泻加重,大便呈水样或稀糊状,带大量粘液,每日7～10次。1周前,反复便血3次,每次50～100ml,且头发、眉毛大量脱落,双手、足指(趾)甲进行性萎缩,皮肤干燥,下肢浮肿。家族中无类似疾病患者。该患者有糖尿病史6年。入院查体:T36.5℃,P70次/min,R20次/min,Bp17/8kPa。皮肤粗糙、脱屑,面部及双眼睑轻度浮肿,毛发稀疏。口腔粘膜无溃疡,舌质红,无苔。心肺正常。腹部轻度膨隆,无肠型及蠕动波,全腹轻度压痛,无反跳痛,未扪及肿块,肝脾不大,移动性浊音阴性,肠鸣音活跃。双下肢轻度凹陷性浮肿,内踝以上皮面有较密集的黑褐斑。双手、足指(趾)甲萎缩明显,左手无名指、食指及右手小指、双足小趾甲床裸露。外周血:RBC5.46×     

上腹疼痛,饱胀,纳差,恶心,呕吐

上腹疼痛、饱胀、纳差、恶心、呕吐济南市中心医院（２５００１３）田淑杰张书元盛文化病历摘要患者女，３８岁。反复发作上腹疼痛、饱胀、纳差、恶心呕吐３年，伴明显消瘦１年入院。曾在当地医院行钡餐检查示胃下垂、十二指肠球部变形，经常规治疗后症状减轻。１年后因精...     

腹胀,黄疸,呕血,精神萎靡

腹胀、黄疸、呕血、精神萎靡山东省立医院（２５００２１）石军杨崇美朱菊人病历摘要患者女，３２岁。停经７个月，因纳差、恶心、呕吐１周，尿黄３天于１９９６年１２月１１月入院。入院１周前无明显诱因的出现恶心、呕吐，每日１０余次，多为胃内容物，伴上腹痛、纳差、...     

头痛,发热,恶心,呕吐

病历摘要患者女，３８岁。因头痛、发热伴恶心、呕吐半个月于１９９７年８月１６日入院。半个月前，患者无明显诱因出现持续性全头痛，伴非喷射性恶心呕吐，体温３７～３８℃。查体：Ｔ３７．７℃，Ｐ８０次／ｍｉｎ，Ｒ２０次／ｍｉｎ，Ｂｐ１７／１０ｋＰａ。神志清楚，...     

发热,腰痛,腹痛,血尿

病历摘要患者男,２５岁,教师。患者因发热,咽痛于１９９７年７月１日住入外院,诊断急性扁桃体炎。该院给予静脉滴注青霉素８００万ｕ／ｄ,２ｄ后发热、咽痛缓解,但出现持续性腰痛、腹痛,呈阵发性加剧,伴有肉眼血尿。于１９９７年７月６日晚转来我院就诊。急诊室以尿路感染、尿路结石收入肾内科病房治疗。既住史：平素健康,无结核史。２月前出现尿频、尿急、尿痛等症状。入院体检：Ｔ３７．５°Ｃ,Ｒ２４次／ｍｉｎ,Ｐ１００次／ｍｉｎ,ＢＰ１６／１２ｋＰａ（１２０／９０ｍｍＨｇ）。神志清,急性痛苦病容,周身皮肤、粘膜未见…     

腹胀,腹痛,低热,血性腹水

第一次查房主任医师：这次讨论的是位老年患者,以发热、腹水、血沉快为特点,至今未明确诊断。先请简要汇报病历。实习医师：患者男,６５岁,因腹胀、腹痛、纳差、低热２周入院。体检：Ｔ３７．８℃。心肺（－）。腹壁静脉无怒张,腹肌略紧张,有柔韧感,全腹未触及包块...     

紫绀,憋喘,腹胀,水肿

病历摘要患者女,４６岁。发现心脏杂音４０余年,活动后心慌,气促伴口唇青紫６年多,因出现腹胀、纳差、憋喘伴双下肢水肿２个月而入院。无蹲踞史,无关节炎及结核病史。查体：Ｔ３６８℃,Ｐ９８次／ｍｉｎ,Ｒ２６次／ｍｉｎ,Ｂｐ１２／９ｋＰａ。身高１６３ｃｍ,体重３５ｋｇ。严重消瘦,呈恶病质,口唇紫绀,颈静脉怒张,杵状指（趾）。双肺呼吸音粗。心前区无隆起,未触及震颤,心尖搏动弥散,心界向双侧扩大,胸骨左缘第三、四肋间闻及Ⅱ／６级收缩期杂音,胸骨右缘第五肋间闻及Ⅱ／６级收缩期杂音,均柔和,Ｐ２消失。蛙状腹、…     

胸闷,心慌,全身无力,心脏骤停

第一次查房主任医师：本例因胸闷、心慌、全身无力入院,住院后出现心脏骤停,经抢救心脏已复跳,但尚未明确诊断。现对其临床资料进行分析讨论。先请汇报病历。住院医师：患者男,２８岁。因发热２天,胸闷、心慌及全身无力３小时入院。入院后询问病史时,患者突然意识丧失,跌倒在地,四肢抽搐。心电监护示室颤。立即给予电击复律,心律转复,静脉给予利多卡因,但心律难以维持,仍反复发生室速;经多次电复律和静注心律平后,心律维持为加速性交界性自身性节律,患者清醒。但此后不久,又反复出现室速、室颤和心跳停顿,给予反复电复律和…     

纳差,口渴,多饮,多尿,发作性四肢瘫痪

第一次查房主任医师：本例患者以纳差、口渴、多饮、多尿及发作性四肢瘫痪为主要表现，曾多处求诊而未予确诊，值得大家讨论。现请报告病历。实习医师：患者女，６０岁。因纳差、厌食、乏力半年，口渴、多饮、多尿２个月，发作性肢体瘫痪１个月入院。半年前不明诱因出现纳...     

Stent, drug, polymer—enefits, risks, and opportunities

It has been well established that use of drug-eluting stents has resulted in marked reduction in neointimal proliferation following stenting and that this is reflected clinically in a very significant decrease in late lumen loss, in-stent restenosis, and target lesion revascularization. This benefit occurs, however, in the setting of delayed endothe-lial and vascular wall healing with its potential for continuing thrombogenicity requiring more prolonged use of dual     

MolecularphenotypesofhumanparvovirusB19inpatientswithmyocarditis Bock CT,Düchting A,Utta F,Brunner E,Sy BT,Klingel K,Lang F,Gawaz M,Felix SB,

AIM: To investigate molecular phenotypes of myocardial B19V-infection to determine the role of B19V in myocarditis and dilated cardiomyopathy (DCM).METHODS: Endomyocardial biopsies (EMBs) from 498 B19V-positive patients with myocarditis and DCM were analyzed using molecular methods and functional experiments. EMBs were obtained from the University Hospitals of Greifswald and Tuebingen and additionally from 36 German cardiology centers. Control tissues were obtained at autopsy from 34 victims of accidents, crime or suicide. Identification of mononuclear cell infiltrates in EMBs was performed using immunohistological staining. Anti-B19V-IgM and anti-B19V-IgG were analyzed by enzyme-linked immunosorbent assay (ELISA). B19V viral loads were determined using in-house quantitative real-time polymerase chain reaction (PCR). For B19V-genotyping a new B19V-genotype-specific restriction fragment length polymorphism (RFLP)-PCR was established. B19V-genotyping was verified by direct DNA-sequencing and sequences were aligned using BLAST and BioEdit software. B19V P6-promoter and HHV6-U94-transactivator constructs were generated for cell culture experiments. Transfection experiments were conducted using human endothelial cells 1. Luciferase reporter assays were performed to determine B19V-replication activity. Statistical analysis and graphical representation were calculated using SPSS and Prism5 software.RESULTS: The prevalence of B19V was significantly more likely to be associated with inflammatory cardiomyopathy (iCMP) compared to uninflamed DCM (59.6% vs 35.3%) (P < 0.0001). The detection of B19V-mRNA replication intermediates proved that replication of B19V was present. RFLP-PCR assays showed that B19V-genotype 1 (57.4%) and B19V-genotype 2 (36.7%) were the most prevalent viral genotypes. B19V-genotype 2 was observed more frequently in EMBs with iCMP (65.0%) compared to DCM (35%) (P = 0.049). Although there was no significant difference in gender-specific B19V-loads, women were more frequently infected with B19V-genotype 2 (44.6%) than men (36.0%) (P = 0.0448). Coinfection with B19V and other cardiotropic viruses was found in 19.2% of tissue samples and was associated with higher B19V viral load compared to B19V-monoinfected tissue (P = 0.0012). The most frequent coinfecting virus was human herpes virus 6 (HHV6, 16.5%). B19V-coinfection with HHV6 showed higher B19V-loads compared to B19V-monoinfected EMBs (P = 0.0033), suggesting that HHV6 had transactivated B19V. In vitro experiments confirmed a 2.4-fold increased B19V P6-promoter activity by the HHV6 U94-transactivator.CONCLUSION: The finding of significantly increased B19V loads in patients with histologically proven cardiac inflammation suggests a crucial role of B19V-genotypes and reactivation of B19V-infection by HHV6-coinfection in B19V-associated iCMP. Our findings suggest that B19V-infection of the human heart can be a causative event for the development of an endothelial cell-mediated inflammatory disease and that this is related to both viral load and genotype.     

腰腿痛,左腹股沟硬块,腰椎,髋,肘骨关节损害

本文讨论一例有十余年腰腿痛、腹股沟硬块、X 线发现腰、髋、肘部骨关节典型损害之病例。通过此例强调慢性布鲁氏菌病骨关节改变为非对称性的多部位、多组织受累。在某些部位(腰、髋、肘)具典型表现,与退行性骨关节病、结核、化脓感染迥然不同。病变进展缓慢,新与旧病灶内破坏与修复并存,以修复占优势。CT 检查在阐明骨关节破坏区之数量、大小、边缘状态以及增生硬化区内细小破坏方面有独到之处。X 线所见结合临床病史和特异性血清学检查能肯定诊断,为进一步治疗提供依据。     

WJC,WJGE,WJGO,WJGS,WJH,WJR6本期刊被PMC收录

本刊讯我们于2010-08-17收到PubMed Central(PMC)的通知,经过美国国立医学图书馆机构咨询委员会The Literature Selection Technical Review Committee评定,决定WJC,WJGE,WJGO,WJGS,WJH,WJR6本期刊被PMC收录.PMC是一个提供生命科学期刊文献的全文数据库,他是由隶属美国国立医学图书馆(National Library of Medicine)的国家生物技术信息中心(National Center for Biotechnology Information)所创建与管理的.(常务副总编辑:张海宁2011-01-08)     

WJC,WJGE,WJGO,WJGS,WJH,WJR 6本期刊被PMC收录

本刊讯我们于2010-08-17收到PubMed Central(PMC)的通知,经过美国国立医学图书馆机构咨询委员会The Literature Selection Technical Review Committee评定,决定WJC,WJGE,WJGO,WJGS,WJH,WJR6本期刊     

WJC,WJGE,WJGO,WJGS,WJH,WJR6本期刊被PMC收录

本刊讯我们于2010-08-17收到PubMed Central(PMC)的通知,经过美国国立医学图书馆机构咨询委员会The Literature Selection Technical Review Committee评定,决定WJC,WJGE,WJGO,WJGS,WJH,WJR6本期刊     

WJC,WJGE,WJGO,WJGS,WJH,WJR6本期刊被PMC收录

本刊讯我们于2010-08-17收到PubMed Central(PMC)的通知,经过美国国立医学图书馆机构咨询委员会TheLiterature Selection Technical Review Committee评定