Retour veineux pulmonaire anormal partiel chez une patiente de 64 ans

Partial anomalous pulmonary venous return (PAPVR) represents 3 % of the congenital cardiopathies. Diagnosis in adults is challenging as clinical symptomatology is non-specific and echocardiographic signs are discrete and misleading potentially confusing with idiopathic pulmonary hypertension. We report the case of a 64-year-old woman in whom we diagnosed PAPVR associated with sinus venosus atrial septal defect. We describe medical history, clinical signs, investigations and postoperative evolution.     

Simulation of the Fissureless Technique for Thoracoscopic Segmentectomy Using Rapid Prototyping

The fissureless lobectomy or anterior fissureless technique is a novel surgical technique, which avoids dissection of the lung parenchyma over the pulmonary artery during lobectomy by open thoracotomy approach or direct vision thoracoscopic surgery. This technique is indicated for fused lobes. We present two cases where thoracoscopic pulmonary segmentectomy was performed using the fissureless technique simulated by three-dimensional (3D) pulmonary models. The 3D model and rapid prototyping provided an accurate anatomical understanding of the operative field in both cases. We believe that the construction of these models is useful for thoracoscopic and other complicated surgeries of the chest.     

Multiple pulmonary rheumatoid nodules

We present a case of 45-year-old female patient with the diagnosis of seropositive rheumatoid arthritis, who was admitted to our rheumatology department with exacerbation of the disease. The patient''s disease activity score (DAS 28) was 6.9. Physical examination revealed changes in the lung auscultation as a rough breathing sound at the middle and lower lobe of the right lung. Chest X-ray revealed multiple nodular densities in both lungs. Lung biopsy was performed for the diagnosis and revealed necrotizing granulomas with central fibrinoid necrosis surrounded by epithelioid cells. Such a histopathological picture is typical for rheumatoid nodules. Finally the patient was treated with rituximab, with significant improvement.     

老年肺纤维化合并肺气肿患者急性加重期病原学调查

目的：了解老年肺纤维化合并肺气肿（CPFE）患者急性加重时下呼吸道病原体分布及其耐药谱。方法入选2013年1月至2014年1月因急性加重在重庆医科大学附属第二医院和重庆市中山医院呼吸科住院的CPFE患者76例，分析痰培养与药敏试验结果。结果76例老年住院患者中，痰培养出88株病原体的患者68例，以革兰阴性菌及真菌为主，检出率位于前6位的病原体分别为鲍氏不动杆菌24株（27.3%）、白假丝酵母18株（20.5%）、肺炎克雷伯菌10株（11.4%）、铜绿假单胞菌8株（9.1%）、嗜麦芽寡养单胞菌6株（6.8%）、阴沟肠杆菌6株（6.8%）。合并两种以上病原体感染的患者26例，对测试抗感染药物存在多药耐药。结论老年CPFE患者急性加重时，机会感染率高且耐药严重，应区分病因、予以合理的抗感染及糖皮质激素等治疗。     

Fetal and Neonatal Imaging and Strategy of Primary Neonatal Heart Transplantation in Hypoplastic Left Heart with Ebstein's Anomaly

We present the anatomic constellation of mitral stenosis/aortic atresia variant of hypoplastic left heart syndrome, Ebstein's anomaly, and partial anomalous pulmonary venous return, an exceeding rare congenital heart defect. Prenatal echocardiography led to concern about the capacity of the right ventricle to increase cardiac output with lung expansion and pulmonary arterial runoff at birth, prompting the precaution of extracorporeal membrane oxygenator standby at delivery. Stage I palliation was not attempted, and control of pulmonary arterial blood flow was achieved with pulmonary artery banding, allowing sufficient ongoing hemodynamic stability. Orthotopic cardiac transplantation, repair of hypoplastic aortic arch, and primary sutureless repair of left pulmonary veins was performed, using dual‐site arterial cannulation and continuous mild hypothermic cardiopulmonary bypass. We discuss how this unique echocardiographic anatomy influenced the surgical decision and point out how it guided therapy toward a strategy of primary transplantation rather than standard staged surgical palliation.     

新型生物可降解腔静脉滤器的设计研究

目的为了弥补目前临床应用中腔静脉滤器的缺陷,本研究设计了一款新型生物可降解型腔静脉滤器,在肺栓塞危险期度过后,滤器可缓慢的降解、吸收,避免了二次取出手术。方法该款滤器由手工制作,分为上下2部分:上方是由6条聚糖乳酸缝线组成的圆锥形过滤结构;下方是聚己内酯支架,支架展开后实现滤器在腔静脉的中央型固定。在超声引导下,将滤器植入到10只犬体内。术后6周手术取出滤器,下腔静脉和肺组织行病理学检查,观察滤器的降解情况、下腔静脉壁的改变以及滤器的降解产物是否导致医源性肺栓塞。结果本研究手工制作了生物可降解滤器,并成功的植入到10只杂交犬的下腔静脉。术后所有犬均正常存活,未发生异常生命体征及伤口感染,有1例犬出现双下肢肿胀。1滤器移位:所有滤器不同程度的向头端移位。有1例犬的植入滤器移位至右房室孔,剩余的9例,滤器移位小于2 cm,仍位于肾静脉以下。2标本肉眼所见:所有的可降解支架被下腔静脉内皮细胞覆盖,肉眼未见明显的变化。滤器植入处下腔静脉壁增厚,但未出现明显狭窄。8例犬可见可吸收缝线完全降解,1例犬出现可吸收缝线被下腔静脉壁包裹,管腔内可见增生的纤维结缔组织和少量炎性细胞浸润,导致约70%的管腔阻塞。3标本HE染色:9例犬下腔静脉均存在炎性反应,中膜和内膜增厚,肺组织切片未见到降解产物所致的肺动脉栓塞和肺动脉壁的炎性反应。结论本研究成功设计了一款生物可降解腔静脉滤器,并通过动物体内实验证实这款滤器具有良好的生物相容性和可降解性。