Factors Affecting Recurrent Deep Vein Thrombosis after Pharmacomechanical Thrombolysis and Left Iliac Vein Stent Placement in Patients with Iliac Vein Compression Syndrome

PurposeThis study evaluated the factors affecting contralateral and ipsilateral recurrent deep vein thrombosis (DVT) after iliac vein stent placement in patients with iliac vein compression syndrome (IVCS).Materials and MethodsData from 130 patients (95 female patients) who underwent catheter-directed thrombolysis and stent placement for IVCS with left lower leg thrombosis at a single institution were retrospectively analyzed. Mean patient age was 69.0 ± 14.0 years old. Median follow-up was 14 months (range, 3–164 months). Anticoagulation therapy was prescribed for 6 months, followed by lifelong antiplatelet therapy. Multivariate logistic regression analysis was performed to evaluate the factors affecting the development of contralateral and ipsilateral recurrent DVT.ResultsSeven patients (5.4%) developed contralateral DVT (median, 26 months; range, 2–61 months), and 11 patients (8.5%) developed ipsilateral DVT (median, 1 month; range, 0–53 months). Stent location (odds ratio [OR], 11.564; 95% confidence interval [CI], 1.159–115.417) and in-stent thrombosis during follow-up (OR, 15.142; 95% CI, 1.406–163.119) were predictors of recurrent contralateral DVT. Thrombophilia (OR, 47.560; 95% CI, 2.369–954.711), remaining inferior vena cava filter (OR, 30.552; 95% CI, 3.495–267.122), and in-stent thrombosis during follow-up (OR, 82.057; 95% CI, 2.915–2309.848) were predictors of ipsilateral DVT.ConclusionsContralateral DVT occurs late and is associated with extension of the iliac vein stent to the inferior vena cava and in-stent thrombosis. Ipsilateral DVT occurs relatively early and is associated with thrombophilia, remaining inferior vena cava filter, and in-stent thrombosis.     

Acute total hip arthroplasty for older patients with acetabular fractures: A meta-analysis

ObjectiveMultiple treatment options for acetabular fractures in geriatric patients exist. However, no large-scale studies have reported the outcomes of acute total hip arthroplasty (THA) in this patient population. We systematically evaluated all available evidence to characterize clinical outcomes, complications, and revisions of acute THA for acetabular fractures in geriatric patients.MethodsMeta-analysis of 21 studies of 430 acetabular fractures with mean follow-up of 44 months (range, 17−97 months). Two independent researchers searched and evaluated the databases of Ovid, Embase, and United States National Library of Medicine using a Boolean search string up to December 2019. Population demographics and complications, including presence of heterotopic ossification (HO), dislocation, infection, revision rate, neurological deficits, and venous thromboembolic event (VTE), were recorded and analyzed.ResultsWeighted mean Harris Hip Score was 83.3 points, and 20% of the patients had reported complications. The most common complication was HO, with a rate of 19.5%. Brooker grade III and IV HO rates were lower at 6.8%. Hip dislocation occurred at a rate of 6.1%, 4.1% of patients developed VTE, deep infection occurred in 3.8%, and neurological complications occurred in 1.9%. Although the revision rate was described in most studies, we were unable to perform a survival analysis because the time to each revision was described in only a few studies. The revision rate was 4.3%.ConclusionsAcute THA is a viable option for treatment of acetabular fracture and can result in acceptable clinical outcomes and survivorship rates in older patients but with an associated complication rate of approximately 20%. Considering the limited treatment options, THA might be a viable alternative for appropriately selected patients.     

增生型原发性醛固酮增多症的研究进展

增生型原发性醛固酮增多症包括特发性醛固酮增多症(IHA)、原发性肾上腺增生(PAH)、糖皮质激素可抑制性醛固酮增多症(GRA)和单侧肾上腺增生症(UAH)。IHA为主要类型,发病与异常的促醛固酮分泌因子的增加及基因变异有关。UAH是一种新的亚型,较为少见。肾上腺静脉采样是鉴别腺瘤与增生、双侧增生和单侧增生的有效方法。     

幽门螺杆菌细胞毒素相关蛋白A在脑梗死中的作用

目的探讨幽门螺杆菌细胞毒素相关蛋白A(Cag-A)与脑梗死发生的关系。方法使用酶联免疫法测定100名患者和50名健康对照者Cag-A抗体,并对脑梗死患者检测CagA-HP-IgG阳性及阴性情况下颈动脉斑块和脑梗死相关因素水平。结果脑梗死组血清CagA-HP-IgG阳性率为62%,而对照组为38%,两组相比有显著性差异(P<0.05)。脑梗死组CagA-HP-IgG阳性100%存在颈动脉斑块;而CagA-HP-IgG阴性者仅55%存在颈动脉斑块,两者之间存在显著性差异(P<0.05)。CagA-HP-IgG阳性的脑梗死患者CRP水平及血纤维蛋白原水平均显著高于CagA-HP-IgG阴性者(P<0.05)。结论Cag-A阳性菌株感染与脑梗死的发生有关,是其发病的危险因素。     

多体素1H-MRS对脑胶质瘤、转移瘤及脑脓肿的鉴别诊断研究

目的 探讨多体素氢质子磁共振波谱（^1H-MRS）在脑胶质瘤、单发转移瘤、体积较大脑脓肿鉴别诊断中的应用价值及胶质瘤瘤体周围的微观结构的改变。资料与方法 搜集脑胶质瘤26例、单发转移瘤9例、大体积脑脓肿4例，均行^1H-MRS检查。比较脑胶质瘤与单发转移瘤瘤体及瘤周胆碱（Cho）／N-乙酰天门冬氨酸（NAA）、Cho／肌酐类物质（Cr）、NAA／Cr值的差别，并做统计学分析；用HE染色、免疫组织化学、电镜检查等重点观察胶质瘤瘤周微观结构改变。结果 各个级别的胶质瘤与单发转移瘤瘤体之间Cho／NAA值分别为3．14±1．61和2．46±0．83，Cho／Cr值分别为2．57±0．93和2．90±1．93、NAA／Cr值分别为0．96±0．53和1．21±0．80，差异均无明显统计学意义（P值均〉0．05）；而瘤周之间的上述比值为1．74±0．98和0．98±0．23，1．72±0．51和1．09±0．35．1．11±0．30和1．11±0．25，除NAA／Cr外均有明显统计学意义（P值〈0．05）。脑脓肿内部出现特征性波谱，扩散加权成像（DWI）上脓腔显示为高信号。胶质瘤瘤周在光镜及电镜下发现已有瘤细胞浸润。结论 使用多体素^1H-MRS结合常规MRI可鉴别胶质瘤、单发转移瘤、不典型脑脓肿，胶质瘤的瘤细胞可以通过毛细血管转移浸润至瘤周。     

Prediction and Detection of Secondary Hemorrhages after Thrombolytic Therapy in Ischemic Stroke

Abstract It is well established that thrombolytic therapy increases the risk of secondary intracerebral hemorrhage in ischemic stroke patients. However, the term “intracerebral hemorrhage” (ICH) covers a wide spectrum from tiny spots of blood to massive space-occupying hematoma. We will review the etiology and clinical consequences of secondary hemorrhage after thrombolysis in ischemic stroke patients and discuss the ability of magnetic resonance imaging (MRI) to predict this phenomenon. MRI is a highly sensitive tool for detection of hemorrhagic transformation after ischemic stroke. The definitions of a so-called symptomatic hemorrhage after ischemic infarction differ considerably and will also be described. Attributing a causal relationship of a clinical deterioration to a secondary hemorrhage is not easy and should be only addressed when it exceeds at least 30% of the infarct volume. In other patients, secondary hemorrhage might be regarded as side effect of reperfusion within the region with the most severe perfusion deficit. Cerebral microbleeds (CMBs) are a frequent finding in patients with leukoaraiosis and appear to be a general marker of various types of bleeding- prone small vessel disease and a predictor of recurrent vascular events. Current data do not support the hypothesis that the detection of CMBs is a useful diagnostic criterion for the exclusion of patients with CMBs from thrombolytic therapy. However, an increased risk for the rare patients with numerous CMBs can not be ruled out.      

Kinetic modeling of PET-FDG in the brain without blood sampling

The aim in this work is to report a new method to calculate parametric images from a single scan acquisition with positron emission tomography (PET) and fluorodeoxyglucose (FDG) in the human brain without blood sampling. It is usually practical for research or clinical purposes to inject the patient in an isolated room and to start the PET acquisition only for some 10–20 min, about 30 min after FDG injection. In order to calculate the cerebral metabolic rates for glucose (CMRG), usually several blood samples are required. The proposed method considers the relation between the uptake of the tracer in the cerebellum as a reference tissue and the population based input curve. Similar results were obtained for CMRG values with the present method in comparison to the usual autoradiographic and the non-linear least squares fitting of regions of interest.     

丹参注射液治疗老年人急性脑梗塞时间窗的探讨

目的探讨丹参注射液治疗老年人急性脑梗塞的最佳时间窗.方法选择老年人急性脑梗塞患者120例,随机按发病后24～48小时、72～96小时、120～144小时初始给予丹参注射液,分成早治、中治、晚治3组,均给药4周,每日1次,其余常规治疗相同.结果4周和8周后观察疗效、神经功能缺损恢复程度,早治组均明显优于其余两组,但梗塞面积扩大或继发出血3组差异无显著性.结论丹参注射液最有效且安全的时间窗是梗塞后24～48小时内.