Septic arthritis due to bacteroides fragilis after pilonidal sinus resection in a patient with rheumatoid arthritis

Summary Bacteroides fragilis is a rare cause of septic arthritis. Most patients with B.fragilis septic arthritis have a chronic joint disease, particularly rheumatoid arthritis, and sources of infection are lesions of the gastrointestinal tract and the skin. We report a 69-year-old male, who developed B.fragilis septic arthritis after pilonidal sinus resection. High level of suspicion of development B.fragilis septic arthritis must be present in patients with chronic joint disease in whom gastrointestinal or skin surgery was previously performed.     

Blood supply of the sinus node artery in beagle dogs

Summary Postmortem coronary angiography was performed in 20 beagles and 15 mongrels, and the origin and distribution of the sinus node arteries (SNAs) were subsequently investigated using soft X-ray radiography, the tissue clearing method, and histological examination. In 19 of 20 beagles, the SNAs consisted of a single atrial branch originating from the right coronary artery, and the distribution pattern of the atrial branch seemed to be uniform. In contrast, the following three different patterns were recognized in the atrial branches forming the SNAs of mongrels: (1) distribution by two atrial branches, i.e., one originating from the right coronary artery and the other from the left circumflex artery, (2) dual distribution by two atrial branches originating from the right coronary artery, and (3) distribution by a single atrial branch originating from the right coronary artery or from the left circumflex artery. In 26 of the 30 dogs which were histologically examined, the SNAs ran outside of the sinus node and were not centrally located. In the beagles, the proximal atrial branch from the right coronary artery reached the atrioventricuolar node area and supplied blood to the atrioventricular node together with the arterial branches derived from the anterior septal artery and posterior septal artery. In addition, the arterial branch of the SNAs reached the atrioventricular junction area. These findings should contribute to clinical, pharmacological, and pathological studies of the cardiovascular system, including studies on cardiac arrhythmias in beagles.     

主动脉窦瘤的诊断和外科治疗

目的:总结主动脉窦瘤的诊断方法和外科治疗经验。方法:35例主动脉窦瘤患者均于体外循环下行主动脉窦瘤修补术。本组包括室间隔缺损19例,主动脉瓣关闭不全11例。除修补窦瘤外,同时行室间隔缺损修补术19例,主动脉瓣替换术2例,主动脉瓣成形术9例,右心室流出道疏通术2例,二尖瓣成形术1例,三尖瓣成形术3例。结果:全组患者无手术死亡,无残余分流。轻度主动脉瓣关闭不全2例,低心排出量综合征2例,频发室性早搏1例,均痊愈出院。35例患者随访3个月～6年,心功能(NYHA)Ⅰ～Ⅱ级。结论:主动脉窦瘤破裂对心功能影响严重。一旦确诊,应尽早手术,同时矫正合并畸形,可获得满意的效果。     

经主动脉窦途径射频消融心动过速临床研究

目的:探讨经主动脉窦途径导管射频消融治愈的快速性心律失常患者的心电图特点及射频消融情况.方法:回顾性分析17例室性心动过速/室性期前收缩、前间隔房性心动过速及前间隔旁路等该类患者的体表心电图、及消融成功时靶点电图等心电生理学特征.结果:经主动脉窦途径导管射频消融治愈室性心动过速/室性期前收缩12例,其中起源于左冠状动脉窦(左冠窦)10例、右冠状动脉窦(右冠窦)2例;源于无冠状动脉窦(无冠窦)的局灶性前间隔房性心动过速3例及前间隔旁路2例.室性心动过速/室性期前收缩心电图特点:Ⅱ、Ⅲ和aVF导联为高大R波,胸导联R波移行较早,V1导联r/S波振幅比≥30%,r波时限(82.2±16.4)ms,V1导联中r/QRS波时限比≥50%,V5、V6导联为高振幅R波、无s波.有效消融靶点心内电图示心室波明显比体表心电图QRS波提前(35.2±21.6)ms.前间隔房性心动过速均能被心房刺激反复诱发和终止,其心电图特点:房性心动过速时P波间期明显窄于窦律时P波间期,Ⅰ、aVL导联P波正向,Ⅱ、Ⅲ和aVF导联P呈负正双向.在心房标测中提示最早的心房激动在希氏(His)束区,但在主动脉无冠窦内标测的心房激动较His束区的心房波提前,其解剖定位于His束上后方,消融靶点无His束电位.前间隔旁路心电图示:窦性心律时呈窄QRS波形,未见预激波,心动过速呈窄QRS形,在无冠窦内记录到最早心房激动点,且无His束电位.17例均消融成功.结论:源于主动脉窦内的室性心动过速/室性期前收缩、前间隔房性心动过速和前间隔旁路具有相对的心内电生理学特征,常规心内膜途径消融困难时应该考虑从主动脉窦途径标测消融策略,把握消融导管与冠状动脉的关系,导管消融治疗安全而有效.     

302例登革热心电图特征研究

目的 分析登革热患者心电图的特征。方法 回顾性分析302例登革热患者（登革热组）和同期300名健康体检者（对照组）的临床资料,对比2组心电图异常情况;进一步分析异常心电图治疗前后的变化及其特点。结果 登革热组存在心电图异常的患者比例（51.32%,155/302）高于对照组（31.00%,93/300）（P < 0.001）;登革热组心电图异常发生频率高于对照组的有ST-T改变（27.81%,84/302）、窦性心动过缓（11.92%,36/302）（P均< 0.05）;有46例心电图异常的患者治疗后复查了心电图,其中窦性心动过缓发生频率较治疗前下降,差异有统计学意义（P < 0.05）;窦性心动过缓的患者共36例,16例（44.44%）合并ST-T改变,高于无窦性心动过缓的患者（25.56%,68/266）,差异有统计学意义（P < 0.05）。结论 登革热患者心电图异常较普遍,主要表现为ST-T改变、窦性心动过缓;窦性心动过缓是登革热最常见的心律失常和较显著的心电图特征,可能有助于诊断登革热。     

介入封堵与外科手术治疗主动脉窦瘤破裂的疗效及安全性

目的比较介入封堵与外科手术治疗主动脉窦瘤破裂(RSVA)的疗效及安全性。方法选取RSVA患者22例,介入封堵治疗10例(介入组),外科手术治疗12例(手术组)。术后随访6—24个月,比较两组临床症状、是否存在残余分流、有无瓣膜反流、封堵器有无移位、肺动脉压变化及心功能状态。结果介入组均完全封堵;与术中比较,术后肺动脉收缩压、肺动脉平均压均降低,差异均有统计学意义(P均0.05);术后即刻造影示少量残余分流1例。手术组完全封堵率为91.67%(11/12);术后出现较大的残余分流和严重低心排量综合征各1例。两组随访期内均未发生右心衰竭、栓塞、感染性心内膜炎、主动脉瓣反流、溶血和死亡等。结论介入封堵治疗主动脉窦瘤破裂与外科修补疗效相当,且具有较好的安全性。     

Comparative Study of Alveolar Bone Height and Implant Survival Rate Between Autogenous Bone Mixed with Platelet Rich Plasma Versus Venous Blood for Maxillary Sinus Lift Augmentation Procedure

Aim and Objectives

The aim of this study was to evaluate changes in alveolar bone height by means of radiographic examination and Straumann implant survival rate following maxillary sinus lift augmentation using autogenous bone in combination with platelet rich plasma (PRP) versus venous blood (VB).

Methods

Fifty patients requiring sinus lift augmentation procedure included in the study were divided into two groups (n = 25). During the procedure the sub antral sinus cavity was augmented using autogenous bone taken from mandibular ramus area and mixed with PRP in one group and autogenous bone mixed with VB in the other group. Orthopantomograms were taken preoperatively, immediate, at 6 months and 1 year postoperatively. Height of alveolar bone at the site of sinus augmentation was measured on the radiographs. One hundred and twenty-one Straumann dental implants were placed after healing period.

Results

Age of the patients in the study groups ranged from 36 to 69 years. Differences in mean values of bone height measurements recorded in the PRP series revealed significant differences among the three subgroups (P = 0.001). Significant differences were noted between immediate postop and 6 month (P < 0.01), immediate postop and year (P < 0.01). In the VB series also significant differences were revealed among the three subgroups (P = 0.0280). Significant differences were noted between immediate postop and 6 month (P < 0.05). Comparison of results of subgroups of the two series at the three intervals revealed significant differences at ‘immediate postop’ values (P = 0.0002) and ‘sixmon’ values (P = 0.0435). Differences between ‘year’ values were not significant. Two implants were lost in PRP group.

Conclusion

The results of this limited study reveals that both groups recorded a good increase in the alveolar bone height after sinus augmentation and showed no significant differences between these groups when compared to each other at 1 year postoperatively. When both sub groups compared with immediate postop to year, PRP group showed significant difference and blood group showed no significant difference.     

高钾血症引起窦室传导动态改变一例

1临床资料患者男性,44岁,因“双下肢水肿12年,恶心、腹泻、乏力1天”于2016年5月24日入院。2004年初,患者无明显诱因出现双下肢水肿,尿中泡沫增多,入住我院肾脏科并行肾脏穿刺活检,诊断为“系膜增生性肾小球肾炎”,予糖皮质激素、血管紧张素转换酶抑制剂及对症支持治疗,病情控制平稳。2014年3月,患者因慢性肾功能衰竭尿毒症期再次入院,主要经血液透析治疗病情好转,之后每周两次血液透析治疗。     

单侧良性蝶窦病变的CT及MRI影像表现特点分析

目的分析单侧良性蝶窦病变的CT及MRI影像表现特点。方法回顾性分析2017年5月至2018年5月我院耳鼻喉科诊治的20例鼻内镜手术后病理证实单侧良性蝶窦病变患者临床资料,均行CT及MRI检查,评估其影像学特征。结果 20例单侧良性蝶窦病变患者中,7例为蝶窦囊肿,CT见蝶窦内呈圆形/卵圆形密度均匀的软组织密度影,其中蝶窦腔膨胀者骨质吸收减少,MRI呈长T1、长T2不规则球形影;7例为真菌性蝶窦炎,CT见其蝶窦内呈不规则点片状钙化斑、云絮状影,毛玻璃样改变,MRI见蝶窦内混杂信号,炎症片状渗出影,真菌结节T2WI低信号;4例为蝶窦脑脊液鼻漏,CT发现蝶窦中单纯软组织密度影,MRI上有线状高信号影将脑脊液高信号影及鼻窦内高信号液体影相连,脑组织、鼻黏膜呈明显低信号;内翻性乳头状瘤2例,CT见蝶窦中软组织不均匀密度影,MRI上肿物不均匀强化,条索样或"脑回征"。结论 CT及MRI可为单侧良性蝶窦病变的诊断及治疗提供全面影像信息,其中CT对病变周围骨质改变、MRI对病变侵袭范围分别有较好显示效果,两者联合对病变有较高的鉴别价值。     

Frontal sinus augmentation: Preliminary results of a new approach in prosthetic orbital reconstruction

PurposeReliable application of endosseous implants for prosthetic facial reconstruction depends on the bone volume available at the defect site. Regarding the orbit, sufficient bone presentation in the medial superior orbital rim is limited due to the frontal sinus. The aim of this article is to report for the first time on the augmentation of the frontal sinus for gaining bone volume for supraorbital implant placement.Materials and methodsBetween 2007 and 2014, five patients with orbital exenteration were treated by frontal sinus augmentation using autogenous cancellous bone graft from the ilium. Extraoral implants for prosthetic orbit reconstruction were placed 4–7 months later. In advance, cadaver surgery was performed to prove the feasibility of the method. Surgical technique is described, and intraoperative images are provided.ResultsThe frontal sinus was successfully augmented in all five patients. No major complications related to the procedure were observed. A total of nine orbital implants were inserted in the augmented bone, thereof one sleeping implant. Six implants were restored prosthetically, two implants were lost at exposure. The observation period ranged from 6 to 97 months (mean: 52.8 months). Mean time for patient rehabilitation was 13 months. High patient satisfaction was achieved with the implant-retained orbital prosthesis.ConclusionThe augmentation of the frontal sinus allows implant placement by providing sufficient bone volume in the medial supraorbital rim. Considering the surgical success of this method and patient satisfaction, this new approach is concluded to be a viable option in a unique subset of patients.