Cardiac perforation and tamponade 3 months after transcatheter PFO closure by STARFlex device: A case report

Percutaneous Patent Foramen Ovale (PFO) closure after paradoxical embolism has become established as a safe, effective and validated procedure. The use of dedicated devices by experienced operators allows for low complication rates and good clinical results in the prevention of paradoxical embolism recurrence. This has led to a widespread use of the technique. However, late complications have been reported after the implantation of different types of devices. We report the first case of cardiac tamponade due to atrial wall erosion, which occurred three months after the implantation of a STARflex device (Nitinol Medical Technologies, Boston, Massachusetts, USA) in a 57 year‐old‐patient Transoesophageal echocardiographic images and surgical views of the perforation related to the device are presented. This report describes treatment of a late complication that arose following implantation of a STARflex device. © 2008 Wiley‐Liss, Inc.     

Age is not a predictor of patent foramen ovale with right-to-left shunt in patients with cerebral ischemic events

BACKGROUND: Patent foramen ovale (PFO) with or without atrial septal aneurysm (ASA) is highly associated with cerebral ischemic events in young patients. The prevalence of PFO and ASA in elderly patients with cerebral ischemic events is not well described. OBJECTIVE: Our study is to evaluate the frequencies of PFO with right-to-left shunt (RLS) and ASA in elderly patients and to determine whether age is a predictor of flow-reversed PFO with RLS in cerebral ischemic events. METHODS: A prospective registry for all consecutive patients with cerebral ischemic events who were evaluated by transesophageal echocardiography (TEE) for the detection of possible cardiac source of embolization was established and maintained in a university hospital. Patients' demographics including age, gender, ethnic origin, cerebrovascular risk factors, and all positive TEE data were collected from July 2000 to August 2001 for statistical analysis. A univariate and multivariate stepwise logistic regression analysis was performed. RESULTS: In older patients the prevalence of PFO with RLS, PFO, and ASA was 25/118 (20%), 28/118 (24%), and 38/118 (32%), respectively, as opposed to younger patients, in whom it was 35/119 (30%), 39/119 (33%), and 38/119 (32%), respectively. Older patients had higher frequencies of hypertension (59; 69%), CAD (25; 21%), and prior history of stroke (23; 20%) as opposed to younger patients. Younger age (<60 years), gender, smoking history, hypertension, hyperlipidemia, CAD, and prior history of stroke were not associated with higher prevalence of PFO with RLS. Patent foramen ovale was associated with ASA (P < 0.001) and LVH (P < 0.019) in patients with TIA and stroke. In multivariate analysis only ASA (P < 0.001) remained significant with PFO, with RLS controlling for age, gender, and LVH. CONCLUSIONS: PFO with RLS and ASA are frequently present in elderly stroke and/or TIA patients and age is not a predictor for PFO. Transesophageal echocardiography should be considered for all stroke and/or TIA patients irrespective of their age.     

药师对本院中成药重复使用的干预效果

目的:探讨药师干预对中成药重复使用的效果,促进中成药的合理使用。方法:选取我院2018年6—12月使用中成药的患者299例为对照组,2019年1—6月使用中成药的患者301例为干预组。对照组采用常规的处方点评,干预组通过完善中成药重复用药点评细则、规范培训点评中药师、加大临床监测力度和中成药合理用药宣教等药学干预手段进行点评,对比干预前后中成药重复使用率。结果:与对照组比较,干预后我院中成药重复使用率由干预前46.15%(138/299)下降至13.95%(42/301),差异有统计学意义(P<0.05);干预前本院中成药重复使用排名前10位的组合中,9组的重复使用率在药师干预后明显下降,仅参芪扶正注射液和复方黄芪益气口服液组合的重复使用率由干预前的1.34%(4/299)上升至3.99%(12/301)。结论:药师干预有效降低我院中成药的重复使用率,促进中成药的合理使用,但仍存在重复用药情况,还需干预。     

我院药学门诊妊娠期用药咨询分析

目的分析医院药学门诊妊娠期用药咨询的基本情况。方法对医院2018年4月至2019年7月的药学门诊妊娠期用药咨询记录进行回顾性统计与分析。结果共提供妊娠期用药咨询525例,孕早期的用药咨询比例最高;咨询量最多的药物类别为中药/中成药(32.85%),其次为抗感染药物(20.33%)。结论中药中成药用药咨询是妊娠期用药咨询的重要内容,是提高药学服务水平、促进妊娠期中药/中成药合理应用的重要环节。     

盐城地区7家医院抗肿瘤中成药使用情况调查及 影响因素分析*

目的：对盐城地区7家医院抗肿瘤中成药使用情况进行调查,以促进抗肿瘤中成药的合理使用。方法：随机抽取7家医院2017年7月至2018年6月间收治的肿瘤患者病历共1933份,对其性别、年龄、支付方式及抗肿瘤中成药的名称、剂型、用法用量、金额等进行统计,分析抗肿瘤中成药使用的影响因素。结果与结论：抽取三级综合医院病历470份、三级专科医院451份、二级综合医院1012份,上述医院抗肿瘤中成药使用率分别为24.9%、30.2%、21.4%,单个病例平均抗肿瘤中成药使用种数分别为0.48（0.48~0.60）、0.48（0.48~0.60）、0.48（0.48~0.48）种。各级医院中艾迪注射液使用率均较高。患者性别、年龄、是否手术对各级医院抗肿瘤中成药使用均无影响;而患者是否化疗、支付方式对抗肿瘤中成药使用存在影响。抗肿瘤中成药不合理使用问题主要表现在用法用量、中成药与西药联用、溶媒等方面不适宜。     

中国药典2015年版及其临床用药须知收载治疗湿疹成方制剂的用药特点分析

目的 分析2015年版《中国药典》及《临床用药须知》收载治疗湿疹成方制剂的用药特点,为临床治疗湿疹提供科学合理的用药参考。 方法 收集《中国药典》及《临床用药须知》2015年版中治疗湿疹的成方制剂,并进行分类、频数统计。 结果 《中国药典》及《临床用药须知》共收录治疗湿疹的外用及口服成方制剂分别为17和20种,其处方组成药物中分别含中药67和94味,外用和口服成方制剂主要为清热祛湿剂。 结论 2015年版药典及临床使用药须知收载治疗湿疹外用及口服成方制剂以清热祛湿为主要治则。外用中药以清热药、开窍药在成方制剂中使用较多,而口服中药以清热药、补虚药在成方制剂中使用较多。     

基于专利数据库中药复方治疗溃疡性结肠炎的用药规律与作用机制分析

目的：研究溃疡性结肠炎专利复方的用药规律和作用机制。方法：从专利数据库中筛选治疗溃疡性结肠炎的中医专利复方,录入数据库,进行频数、聚类和关联分析,再通过中药系统药理学数据库与分析平台（Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform,TCMSP）筛选排名前十的高频药的活性成分,然后通过DrugBank数据库找到这些成分对应的作用靶点,并通过基因免疫功能和基因通路富集分析找到这些靶点对应的免疫功能和信号通路。结果：总共发现治疗溃疡性结肠炎的专利复方224个,涉及中药387味;排名前十的高频药依次是黄连、甘草、白术、白芍、黄芪、白及、党参、白头翁、地榆、木香,主要使用的是补益药和清热药;发现中药配伍10对、关联规则16条;在排名前十的高频药中筛选出83个活性成分及其146个作用靶点,这些靶点作用于B细胞增殖、T细胞因子分泌等27个免疫功能,以及TNF信号通路、IL-17信号通路等47条信号通路。结论：专利数据库中治疗溃疡性结肠炎的中药复方用药规律符合临床实际,其作用机制和溃疡性结肠炎的病理机制较符合。     

Orthodeoxia-platypnea due to intracardiac shunting relief with transcatheter double umbrella closure

The safety and efficacy of transcatheter clamshell occlusion of patent foramen ovale for relief of severe arterial desaturation and dyspnea in the upright position due to intracardiac shunting were examined in eight patients with excessive risk of surgical patent foramen ovale closure. All patients had successful reduction of intracardiac shunting with an immediate rise in oxygen saturation ?95% by implantation of a clamshell device on the atrial septum. Despite two early incidents of device embolization, retrieval and immediate re-implantation, and one patient with nonsustained atrial and ventricular arrhythmias, there were no adverse clinical sequelae. In follow-up evaluation transcatheter clamshell closure of patent foramen ovale has provided persistent relief from shuntrelated arterial desaturation and symptomatology in all living patients. © 1995 Wiley-Liss, Inc.     

Refractory hypoxemia in inferior myocardial infarction from right-to-left shunting through a patent foramen ovale: A case report and review of the literature

Right ventricular (RV) infarction is a well-recognized complication of some acute inferior myocardial infarctions. Recently, there have been numerous case reports of RV infarctions complicated by severe refractory hypoxemia secondary to right-to-left shunting through a patent foramen ovale. An additional case missed by transthoracic echocardiography and cardiac catheterization is reported and the English literature on the subject is reviewed.