Cor triatriatum associated with partial anomalous pulmonary venous connection to the coronary sinus: Echocardiographic and angiocardiographic features

Summary An infant girl is described who had cor triatriatum and partial anomalous pulmonary venous connection of the left pulmonary veins to the coronary sinus, the first report of this combination of lesions. The infant also had a Dandy-Walker malformation and multiple facial and intrathoracic hemangiomas. The cardiac diagnosis was made by two-dimensional echocardiography. Cardiac catheterization and angiography confirmed the findings and also demonstrated a persistent left superior vena cava draining to the coronary sinus. The infant underwent successful surgical repair. Partial anomalous pulmonary venous connection and left superior vena cava not infrequently are associated with cor triatriatum. Although two-dimensional echocardiography is sensitive for the detection of cor triatriatum, preoperative cardiac catheterization is necessary to identify unequivocally systemic and pulmonary venous connections.     

肠瘘患者腔静脉导管感染的回顾性分析

目的了解肠瘘患者腔静脉导管感染的发生率、细菌菌谱及药敏情况。方法对1998年1月至2001年4月收治的使用腔静脉导管进行全肠外营养(TPN)的肠瘘患者进行回顾性分析。结果216例肠瘘患者,共进行了358次腔静脉置管,腔静脉导管尖端培养阳性的有88次(24.6%),腔静脉导管平均使用时间为(16.9±13.0)d。88次腔静脉导管感染的尖端共培养出95株细菌,其中革兰阴性菌54株,占56.8%;其次为革兰阳性菌35株,占36.8%;真菌6株,占6.4%。根据药物敏感试验结果及临床表现,有16例患者更换了抗生素,4例改用抗真菌药物,所有患者均治愈。结论对于肠瘘患者,腔静脉感染仍是实施静脉营养的主要并发症之一,革兰阴性细菌感染最常见。     

Warfarin or Low-Molecular-Weight Heparin Therapy does not Prolong Pig-To-Primate Cardiac Xenograft Function

Microvascular thrombosis is a prominent feature in cardiac delayed xenograft rejection (DXR). We investigated the impact of warfarin or low-molecular-weight heparin (LMWH) anti-coagulation on xenograft function using a heterotopic pig-to-primate model. Donor hearts were from CD46 transgenic pigs and baboon immunosuppression included tacrolimus, sirolimus, anti-CD20 and TPC, an alpha-galactosyl-polyethylene glycol conjugate. Three groups of animals were studied. Group 1 (n = 9) was treated with warfarin, Group 2 (n = 13) with LMWH and Group 3, received no anti-coagulant drugs. The median duration of xenograft function was 20 days (range 3-62 days), 18 days (range 5-109 days) and 15 days (range 4-53 days) in Groups 1 to 3 respectively. Anti-coagulation achieved the targeted international normalized prothrombin ratio (INR) and anti-factor Xa levels consistent with effective in vivo therapy yet, no significant impact on median xenograft function was observed. At rejection, a similar histology of thrombosis and ischemia was apparent in each group and the levels of fibrin deposition and platelet thrombi in rejected tissue was the same. Anti-coagulation with warfarin or LMWH did not have a significant impact on the onset of DXR and microvascular thrombosis. However, a role for specific anti-coagulant strategies to achieve long-term xenograft function cannot be excluded.     

介入联合手术治疗门静脉血栓形成7例

目的 评价介入联合手术治疗门静脉血栓形成的疗效。方法 对7例术前确诊为门静脉血栓形成者行开腹经肠系膜上静脉的门静脉内手术取栓、局部溶栓和门静脉狭窄/闭塞段球囊扩张、内支架置入术。2例因小肠坏死、1例因肠腔明显狭窄而同时行部分小肠切除术。结果 7例均治疗成功。术前腹痛、腹胀及消化道症状消失,腹水基本消失。随访3～24个月,平均16个月,均健在,无消化道出血。多普勒超声复查显示门静脉血流通畅。结论 介入联合手术是治疗门静脉血栓形成的安全、有效方法。     

The high prognostic value of the histologic grade at the deep invasive front of tongue squamous cell carcinoma

BACKGROUND: Although many histopathologic factors in squamous cell carcinoma of the tongue predict the prognosis, the major predictive factors have not been identified clearly. This study analyzed the prognostic value of the histologic grade at the deep invasive front of tongue squamous cell carcinoma. METHODS: The clinicopathologic features of 124 consecutive patients seen between January 1985 and December 1999 with previously untreated squamous cell carcinoma of the tongue were reviewed. Their mean age was 58.5 years (range: 23-90) and the male-female ratio was 1.8: 1 (79 men and 45 women). There were 41, 40, 30, and 13 cases at stage I to stage IV, respectively. The clinicopathologic factors, especially the histologic grade at the deep invasive front (invasive front grade, IFG), were analyzed to determine factors predicting prognosis. RESULTS: The 5-year disease-free survival rate of the patients treated with curative aim only was 66.7%. Clinicopathologic factors significantly associated with the prognosis were T classification, tumor size, stage classification, tumor depth, macroscopic appearance, cervical lymph node metastasis (nodal metastasis), microvascular invasion, and IFG. In a multivariate analysis, patients with tumor depth >/=4 mm, IFG >/=8 points, and nodal metastasis had a reduced disease-free survival and IFG >/=11 points had a predictive value for nodal metastasis (odds ratio: 7.34; P = 0.0019). CONCLUSION: This study found that a high IFG malignancy score had a high prognostic value for squamous cell carcinoma of the tongue.     

经大隐静脉穿刺置管溶栓治疗急性期髂股静脉血栓形成

目的:探讨经大隐静脉入路置管溶栓治疗髂股静脉血栓形成的应用价值。方法:对18例急性期髂股静脉血栓形成的患者在下腔静脉滤器植入术前提下,经大隐静脉入路置管溶栓治疗。结果:18例患者经大隐静脉穿刺成功置管,技术成功率为100%,治疗有效率为100%。置管期间无不良反应及并发症发生;平均住院时间为12.5d。结论:经大隐静脉入路置管溶栓介入治疗急性期髂股静脉血栓操作简便,经济实用,安全有效。     

Portal thrombosis: Percutaneous transhepatic treatment with urokinase — A case report

We present a case report of a patient suffering from portal and superior mesenteric vein thrombosis secondary to splenectomy. No surgical procedure could be performed due to the extension of thrombus.Local fibrinolysis treatment with urokinase through a percutaneous transhepatic approach was decided upon, and this procedure had a successful patient outcome.     

危重患儿下肢深静脉血栓10例

目的：探讨危重患儿下肢深静脉血栓（DVT）的危险因素、诊断及治疗。方法：回顾性分析10例DVT的临床资料。结果：9例患儿应用股静脉插管。诊断DVT后均接受抗凝，祛聚综合治疗。4例行溶栓治疗；10例全部治愈，随访9例无复发，1例固原发病行截肢。结论：DVT在儿科发病率低，中心静脉插管是儿科DVT的主要危险因素，综合应用溶栓、抗凝及祛聚治疗，效果良好，后遗症少。     

Inhibition and reversal of platelet-rich arterial thrombus in vivo: direct vs. indirect factor Xa inhibition

BACKGROUND/OBJECTIVE: The efficacy of a direct factor (F)Xa inhibitor, ZK-807834, was compared with indirect inhibition by enoxaparin for inhibition and deaggregation of acute platelet-rich thrombi in a well-characterized porcine carotid injury model. METHODS: A crush injury was performed on a randomly chosen carotid artery and the thrombus allowed to propagate for 30 min. Pigs then received intravenous drug for 35 min: ZK-807834-Dose 1 (40 microg kg(-1) bolus + 1.5 microg kg(-1) min(-1) infusion, n=6); ZK-807834-Dose 2 (20 microg kg(-1) bolus + 0.75 microg kg(-1) min(-1) infusion; n=6); enoxaparin (1 mg kg(-1) bolus; n=6); or saline (n=6). Five minutes after drug initiation, the contralateral artery was injured. Thrombus size was monitored by scintillation detection of autologous 111In-platelets. RESULTS: The prothrombin time ratio was 2.2 +/- 0.1; 1.4 +/- 0.3; 1.2 +/- 0.9 and 1.1 +/- 0.2, respectively. ZK-807834-Dose 1 significantly inhibited carotid platelet deposition (525 +/- 226 x 10(6) cm(-2); P = 0.008), whereas ZK-807834-Dose 2 (2325 +/- 768) and enoxaparin (1236 +/- 383) were not different from saline (2776 +/- 642). Thrombus deaggregation was greatest for animals receiving ZK-807834-Dose 1 (473 +/- 185). Neither ZK-807834-Dose 2 (1588 +/- 480) nor enoxaparin (1618 +/- 686) was different from saline control (2222 +/- 598). CONCLUSIONS: Direct FXa inhibition with ZK-807834, at a prothrombin time ratio of 2.2, effectively inhibits thrombosis and promptly deaggregates thrombi induced by arterial injury. In contrast, indirect FXa inhibition with enoxaparin was ineffective.