Prenatal Diagnosis of Left Pulmonary Artery-to-Pulmonary Vein Fistula and Its Successful Surgical Repair in a Neonate

Pulmonary arteriovenous fistula is a rare disease. To the best of our knowledge, prenatal diagnosis of a fistula between the left pulmonary artery and the left pulmonary vein has not been described in the medical literature. We report a case of the prenatal diagnosis of a left pulmonary artery-to-pulmonary vein fistula, followed by successful neonatal surgical repair.     

Cardiac Plasmacytoma: A Rare Clinical Entity

Primary malignant cardiac tumors are rare. Among these tumors, cardiac plasmacytoma is extremely rare and is the subject of few case reports. We present the case of a 73-year-old man who had isolated cardiac plasmacytoma 26 years after successful treatment of an axillary plasmacytoma. Multiple imaging methods—including echocardiography, cardiac magnetic resonance, and positron-emission tomography/computed tomography—were valuable and complementary to each other in this patient''s diagnosis and optimal management. His case illustrates the use of these techniques in the successful diagnosis and treatment of a rare clinical entity, cardiac plasmacytoma.     

The Preoperative Evaluation of Infective Endocarditis via 3-Dimensional Transesophageal Echocardiography

Transesophageal echocardiography continues to have a central role in the diagnosis of infective endocarditis and its sequelae. Recent technological advances offer the option of 3-dimensional imaging in the evaluation of patients with infective endocarditis. We present an illustrative case and review the literature regarding the potential advantages and limitations of 3-dimensional transesophageal echocardiography in the diagnosis of complicated infective endocarditis.A 51-year-old man, an intravenous drug user who had undergone bioprosthetic aortic valve replacement 5 months earlier, presented with prosthetic valve endocarditis. Preoperative transesophageal echocardiography with 3D rendition revealed a large abscess involving the mitral aortic intervalvular fibrosa, together with a mycotic aneurysm that had ruptured into the left atrium, resulting in a left ventricle-to-left atrium fistula. Three-dimensional transesophageal echocardiography enabled superior preoperative anatomic delineation and surgical planning. We conclude that 3-dimensional transesophageal echocardiography can be a useful adjunct to traditional 2-dimensional transesophageal echocardiography as a tool in the diagnosis of infective endocarditis.     

Unusual Presentation of Listerial Myocarditis and the Diagnostic Value of Cardiac Magnetic Resonance

Listeria monocytogenes is an infrequent cause of bacterial myocarditis. Myocarditis without evidence of endocarditis is even rarer. Management in such cases involves early diagnosis, antibiotic therapy, and emergency treatment of arrhythmias.We report the case of a 47-year-old man who presented with features of acute ST-segment-elevation myocardial infarction complicated by ventricular tachycardia that necessitated urgent electrical cardioversion. Contrast-enhanced cardiac magnetic resonance images revealed hypertrophy, necrosis, and a mass that was determined to be an abscess caused by L. monocytogenes. Antibiotic treatment led to resolution of the listerial myocarditis.In addition to reporting our patient''s case, we discuss the comparative advantages of cardiac magnetic resonance versus transthoracic echocardiography in characterizing myocarditis, upon presentation and in follow-up evaluation.     

Anomalous Origin of the Left Main Coronary Artery from the Right Coronary Artery with a Preaortic Course

We report the case of a 51-year-old woman who presented with stable angina pectoris and Canadian Cardiovascular Society class II functional capacity. An electrocardiogram during a treadmill exercise test showed substantial ST-segment depression in the inferolateral leads. Coronary angiograms revealed an anomalous origin of the left main coronary artery from the opposite sinus of Valsalva and an interarterial course between the ascending aorta and pulmonary artery. Although this phenomenon is dangerous, the patient refused further examination. We discuss the diagnosis and treatment of patients who have an anomalous origin of a coronary artery from the opposite sinus of Valsalva.     

Mitral Perivalvular Leak after Blunt Chest Trauma: A Rare Cause of Severe Subacute Mitral Regurgitation

Blunt chest trauma is a very rare cause of valve disorder. Moreover, mitral valve involvement is less frequent than is aortic or tricuspid valve involvement, and the clinical course is usually acute. In the present report, we describe the case of a 49-year-old man with a perivalvular mitral injury that became clinically manifest one year after a violent, nonpenetrating chest injury.This case is atypical in regard to the valve involved (isolated mitral damage), the injury type (perivalvular leak in the absence of subvalvular abnormalities), and the clinical course (interval of one year between trauma and symptoms).     

Bacterial Pancarditis with Myocardial Abscess: Successful Surgical Intervention in a 14-Month-Old Boy

A 14-month-old boy with a structurally normal heart presented with signs of cardiac tamponade caused by purulent pericarditis. During his hospital stay, mitral and tricuspid valve endocarditis developed, and a ventricular septal abscess expanded despite appropriate, prolonged antibiotic therapy for methicillin-resistant Staphylococcus aureus. The day before scheduled surgical correction, the abscess ruptured, creating a septal aneurysm. Surgical intervention resulted in an excellent outcome. Throughout the patient''s 67-day hospitalization, the use of echocardiography was crucial in monitoring and diagnosis.In addition to reporting this case, we discuss our diagnostic and treatment considerations. To our knowledge, this is only the 4th report of S. aureus bacterial pancarditis with myocardial abscess.     

Giant Coronary Artery Aneurysms: Review and Update

Giant coronary artery aneurysms are rare, with a reported prevalence of 0.02% to 0.2%. Causative factors include atherosclerosis, Takayasu arteritis, congenital disorders, Kawasaki disease, and percutaneous coronary intervention. Most giant coronary artery aneurysms are asymptomatic, but some patients present with angina pectoris, sudden death, fistula formation, pericardial tamponade, compression of surrounding structures, or congestive heart failure. Clinical sequelae include thrombus formation, embolization, fistula formation, and rupture. Surgical correction is generally accepted as the preferred treatment for giant coronary artery aneurysms. We present an illustrative case of a giant 70 × 40-mm coronary artery aneurysm in a 56-year-old man who declined surgery and died one month later. In addition, we provide a review of the medical literature on giant coronary artery aneurysms.     

超声内镜诊断胰腺内分泌肿瘤的价值

目的探讨超声内镜诊断胰腺内分泌肿瘤的价值．方法胰腺内分泌肿瘤患者１０例,进行了超声内镜、血管造影、ＭＲＩ,ＣＴ及超声波检查．结果超声内镜对胰腺内分泌肿瘤的诊断率为９２３％,其中肿瘤直径在２ｃｍ以下的诊断率为８７５％,肿瘤轮廓清晰,边缘整,内部回声呈强回声、低回声、等回声和混合性回声;超声波的诊断率为４６２％;ＣＴ平扫和增强扫描的诊断率分别为３０７％和４６２％;ＭＲＩＴ１呈低信号、Ｔ２呈高信号,诊断率为７２７％;血管造影的诊断率为８４６％．结论超声内镜对胰腺内分泌肿瘤的定位诊断和定性诊断优于其他影像学检查,特别是对胰腺小肿瘤的诊断,更显示出它的价值．     

肝纤维化的诊断和治疗进展

肝纤维化的诊断手段主要包括病理组织学检查、血清学指标检测及影像学检查，其中肝活检组织病理学检查是诊断肝纤维化和肝硬化的“金标准”，但也有其局限性，肝纤维化的血清学指标包括血清Ⅲ型前胶原氨基端肽、血清层连蛋白P1、血清透明质酸、血清Ⅳ胶原、血清Ⅵ型胶原、基质金属蛋白酶等，这些指标和肝组织病理学纤维化程度有较好的相关性。抗纤维化的治疗包括针对原发病的病因治疗和针对抗肝纤维化本身的治疗。本文对此作一综述。     

肺吸虫病14例临床分析

肺吸虫病是由主要寄生在肺部的一组并殖吸虫所引起的慢性人畜共患寄生虫病。临床表现多变，城市人群发病相对较少。为进一步增强对肺吸虫病的认识，现将我院1990年以来收治的14例肺吸虫病患者的临床资料进行回顾性分析。对象与方法1．对象：收集190年1月～互999年8月住院治疗的     

Clinical and experimental research on weile jiaonang for peptic ulcer

AIM To observe the therapeutic effect of weile jiaonang (WLJN) for peptic ulcer (PU) and its toxicity toanimals, and to find out the nontoxic Chinese medicines in replacing those chemical medicines with sideeffect.METHODS Five hundred and forty patients with PU were divided into three groups, therapeutic group byWLJN, control group taking famotidine and combined group with WLJN and famotidine. One hundred andeighty patients in each group were studied. The diagnosis of 540 patients with PU is in accordance with thebasis provided by the National Scientific Congress of Digestive System Disease convened in Hangzhou, 1978.The study followed the criterion provided by this Congress.RESULTS Total effective rate in therapeutic group was 93.3%, and 93.3% in control group. Combinedgroup achieved a total effective rate of 100%. For all three groups, there was no significant differencestatistically, but the control group appeared obvious side effects. The result of acute toxic experiments onwhite mice showed that there no death and toxic side effect even the highest dosage was given, which wasequivalant to 120 times to the dosage of patients. The result of chronic toxic experiment showed there was noobvious pathologic change in three dosed groups. The tails of mice in dosed groups were more smooth delicateand cleaner than those in control group.CONCLUSION Through observation in clinic and exprimental animal, it is proved that weilejiaonang isparticularly effective and safe Chinese patent drug against PU.     

112例大动脉炎临床分析

目的 探讨大动脉炎的临床特征和活动期治疗方法，分析各种治疗方案的疗效及疾病转归。方法 对112例大动脉炎患者的临床表现、实验室检查、治疗方法和疾病转归进行分析。结果 112例中，外科手术治疗12例(10．7％)；介入治疗15例(13．4％)，患者病情均无活动；激素和(或)免疫抑制剂治疗66例(58．9％)，其中57例病情活动，经治疗后，44例病情稳定(77．2％)，7例好转(13．2％)，6例无效(11．3％)。结论 大动脉炎临床表现各异，治疗方法包括介入治疗、外科手术处理有症状的血管狭窄，激素和(或)免疫抑制剂治疗可控制病情活动。     

结节性多动脉炎的诊断和治疗进展

结节性多动脉炎（PAN）是最早被阐述的系统性血管炎，是累及中等大小动脉或小动脉的一种坏死性血管炎，常有多系统受累。临床表现复杂且缺乏特异性，往往没有肾小球肾炎、肺损害及抗中性粒细胞胞浆抗体（ANCA）。PAN的诊断依赖于临床表现、实验室检查以及病理检查，找出其重要线索如：周围神经病变、胃肠道损害、高血压、HBsAg阳性等才能作出正确诊断。PAN的治疗主要是肾上腺糖皮质激素，对有重要脏器损害的患者使用细胞毒药物和血浆置换也是必要的。     

多发性骨髓瘤92例临床分析

目的　对多发性骨髓瘤(MM)的临床特点进行总结,为诊断和治疗提供参考。方法　对92例MM患者的临床资料进行回顾分析。结果　(1)初始化疗采用M2、VAD或MP方案有效率无显著性差异。(2)初始VAD方案化疗是否有效与患者预后相关。初治有效组和无效组中位生存期分别为43. 1个月与4. 0个月(P<0. 05)。(3)骨膦可防治骨骼进一步的破坏,但骨X线片未显示明显的骨质再钙化。化疗中加用骨膦治疗可延长患者的生存期(P<0. 05)。结论　初始VAD方案化疗有效者预后较好,中位生存期可达43. 1个月,加用骨膦治疗可延长生存期。在细胞遗传学和基因表达谱基础上行个体化治疗可能会提高疗效。     

Trousseau Syndrome in a 25-Year-Old Woman with Occult Colon Malignancy,Lynch Syndrome,and Chronic Thromboembolic Pulmonary Hypertension

We present a rare case of thrombosis associated with an occult colon malignancy (Trousseau syndrome) in a 25-year-old woman who also presented with previously unidentified Lynch syndrome and acute-on-chronic thromboembolic pulmonary hypertension. Staged treatment included bilateral pulmonary endarterectomy under deep hypothermic circulatory arrest, followed 11 days later by laparoscopic subtotal colectomy and creation of a primary anastomosis. The patient tolerated both procedures well and recovered normal functional status. Final pathologic analysis of the resected colon mass revealed a pT3N0, stage IIA adenocarcinoma; no adjuvant therapy was administered. At her one-year follow-up visit, the patient was cancer-free, remained on lifelong apixaban anticoagulation, and was undergoing routine monitoring and genetic counseling. This case highlights the need for multidisciplinary management of a patient with severe chronic thromboembolic pulmonary hypertension and a concomitant malignancy.     

Coarctation of Persistent 5th Aortic Arch: First Report of Catheter-Based Intervention

Persistent 5th aortic arch, originally called double-lumen aortic arch, is a rarely reported cardiac developmental anomaly that results in systemic-to-systemic or systemic-to-pulmonary shunting. When this malformation occurs, other intracardiac defects are almost always present. We report the case of a 7-month-old girl who presented with a heart murmur; she was found to have an interrupted 4th aortic arch and coarctation of a persistent 5th aortic arch, with no other defects. To our knowledge, this is the 3rd report of a pediatric patient with this condition in isolation, and the first report of its diagnosis and treatment by means of cardiac catheterization and balloon angioplasty.     

25例肝结核临床分析

目的探讨肝结核的诊断和治疗措施。方法报道1999年1月~2005年1月收治确诊的肝结核病人25例,对其临床资料进行回顾分析。结果25例病人临床表现主要为发热、腹痛、腹胀和肝肿大,反复肝功能异常。病理类型粟粒型8例,结节型17例。5例手术切除治疗。所有病人都经过9~18月的抗结核治疗,经随访预后良好。结论肝结核临床表现和影像学表现多样,且无特异性,误诊误治率高。肝结核诊断需综合临床表现、实验室检查、影像学检查和病理检查,确诊手段主要是肝组织活检,系统性的抗结核治疗及选择性手术治疗是肝结核的主要有效治疗手段。     

我国结核病临床诊治的回顾与展望

我国结核病诊断经历了以痰涂片萋尼染色镜检及普通X线检查（包括胸片）为主要诊断手段发展到各种新的诊断方法的临床应用,使结核病的诊断水平大大提高.结核病的治疗从最初的疗养疗法到链霉素和利福平的问世,开创了结核病短程化疗的新纪元.未来我国结核病的诊断应尽快普及新快速诊断技术和方法,包括发光二极管（LED）荧光显微镜、BACTEC MGIT 960全自动分枝杆菌培养系统、Xpert Mtb/RIF检测法、分子线性探针测定法（LPA）、基因芯片法、RNA恒温扩增实时检测（SAT）、环介导等温扩增法（LAMP）,以及支气管内超声引导针吸活检术（endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA）等,以提高结核病和耐药结核病的早期诊断水平.同时,拓宽结核病治疗手段,包括抗结核新药及药物新靶点的研究、结核病免疫治疗及治疗性疫苗的研究、结核病介入治疗的研究、结核病外科治疗的研究,以及纳米介导靶向治疗的研究等,最终提高治愈率.     

白塞氏病的诊断与治疗进展

白塞氏病是一种慢性复发性炎症过程，累及多器官，其常见症状为复发性口腔、外阴溃疡。其他包括色素膜炎、皮肤结节或小脓疱、滑囊炎、脑膜脑炎、大动脉炎、静脉炎、肠道溃疡。本病无特异性病理改变和血清学改变，临床诊断较困难。