巯甲丙脯酸引起窦室传导心电图1例报告

赵某,男,68岁。因胸闷心悸,气急不能平卧伴下肢浮肿反复发作5年余,症状加重1周,于1987年12月17日入院。患者自1982年起出现胸闷心悸,气短伴轻微咳嗽,少量白色泡沫痰,夜间有阵发性呼吸困难发作。逐渐症状加重,以至反复出现气急不能平     

左冠状动脉回旋支缺如1例

1病例报告患者,男,56岁。因间断胸闷6个月,加重10 d入院。6个月前,患者反复发作胸闷,无明显胸痛,胸闷发作与劳累和天气变化有关,持续30 min左右,有时伴有心悸和气短,近10d来,胸闷发作频繁,持续不缓解,院外心电图有“心肌缺血”,疑诊冠心病收住院。既往患者无高血压、糖尿病、先心病等病史。入院后查体:BP130/85 mmHg,双肺无音,心界不大,HR68 bpm,律齐,心音有力,未闻杂音,双下肢无水肿。入院后查血脂:Cho6.29 mmol/L,TG3.4 mmol/L,HDL-C1.03mmol/L,LDL-C4.88 mmol/L。血糖7.5 mmol/L。心电图STⅡ、Ⅲ、aVF水平性下移约0.05 mV。超…     

介入治疗冠状动脉-肺动脉瘘1例

1　临床资料　患者 ,男 ,5 5岁 ,主因“胸闷、心悸 1个月 ,加重 3ｄ”入院。 1个月前 ,患者无明显诱因出现胸闷、心悸 ,活动后加重 ,口服“丹参滴丸”“地奥心血康”等药物后略缓解 ,后症状反复出现。曾做心电图示偶发房早 ,因既往有“颈椎病”未予注意 ,3ｄ前症状加重 ,伴恶心、大汗 ,含服“丹参滴丸”后稍有好转 ,为进一步诊治入院。否认高血压、糖尿病史。入院查体无明显异常 ,生化检查示 :总胆固醇 4.71ｍｍｏｌ/Ｌ ,甘油三脂 3 .44ｍｍｏｌ/Ｌ ,胸片、心电图及心脏超声未发现异常。ＨＯＬＴＥＲ检查提示心肌缺血改变 ,后行运动试验检查…     

冠状动脉左主干起源于右冠状窦一例

病例资料患者,男,32岁。患者于1年前始出现发作性心前区刺痛、胸闷,1h前饱食后睡眠中感心悸、胸闷、全身发抖来就诊。体检：心前区无隆起,未触及震颤,心界无明显扩大,心率68次／分,律不齐。可闻及早搏1～3次／分。     

以剑突下不适、恶心为主要症状的Wellens综合征一例

一、病例介绍 患者老年女性,主因"反复剑突下不适1年,加重10 d"于2020年4月28日入住临沂市中心医院诊治.患者于1年前无明显诱因反复出现剑突下不适,伴有恶心与心慌,每次持续约5～6 min,多在晚上发作.近10 d发作症状加重,发作次数增多.发作时无明显胸痛或胸闷.患者11年前因"左侧乳腺肿瘤"行乳腺全切术(具...     

椎基底动脉供血不足误诊为癔症1例

病例男,23岁,某部一级士官,因发作性头晕、意识障碍2个月入院。患者2个月前与人争吵后出现头晕、恶心,伴心慌、胸闷等不适,休息后无明显缓解,进而出现意识障碍、四肢肌肉震颤,无双眼上翻,无口吐白沫,四肢无明显抽搐。     

白塞病致右颈总动脉假性动脉瘤一例

患者　男 ,39岁。因口腔、外阴部溃疡及皮肤丘疹反复发作 2年 ,右颈部突发肿物伴疼痛 2 0天就诊。患者于 2年前出现口腔、外阴部溃疡 ,皮肤丘疹伴轻痛 ,确诊为白塞病 ,行对症治疗 ,2年来症状反复发作。 2 0天前 ,无诱因突发右颈部肿物 ,随后出现右颈部疼痛 ,向头部、右肩背部放射 ,较剧烈 ,平卧时疼痛难以忍受 ,伴声音嘶哑、胸闷。查体 :血压17.3/ 7.9ｋＰａ ,右颈部可见一肿物 ,椭圆形 ,约 5ｃｍ× 6ｃｍ ,皮肤表面无红肿、破溃 ,囊性感 ,质韧 ,边界清 ,不活动 ,皮温不高 ,可扪及搏动 ,未及震颤 ,轻压痛。肿物不随吞咽移动 ,听诊可闻及收缩…     

房室结消融术后起搏器置入治疗重度心衰合并快速性房颤1例

l病例报告、患者男,64岁,因“反复胸闷、气短11年,加重伴心悸1个月”入院。患者11年前出现活动后胸闷、气短,伴心悸、疲乏、下肢无力,休息后可缓解。7年前诊断为扩张性心肌病,2年前症状加重,休息状态下仍有胸闷、气短,伴心悸、咳嗽及夜间阵发性呼吸困难。超声心动图提示EF25％,行心脏再同步化（CRT）治疗后症状好转。近1个月来,反复于轻微活动后出现呼吸困难及夜间阵发性呼吸困难,心电图提示心房颤动。人院诊断;     

左冠状动脉窦瘤一例

患者女,49岁,已婚.因"反复发作活动后心前区不适、眼部烧灼感4个月,再发3 d"为主诉入院.缘于4个月前多于活动后出现心前区不适,伴咽部烧灼、紧缩感,有时伴有左上臂酸胀、困痛,无心慌、胸闷、气短等症状,休息数分钟可自行缓解,每月发作1 ～ 2次,就诊于县医院,诊断为"心肌缺血",按"冠心病"予以对症治疗后症状稍改善,出院后继续服药治疗,症状仍反复,每天发病至数十次,体力活动明显受限.     

硝普钠致尿潴留1例

1 临床资料患者,男性,65岁,因心悸、胸闷气促反复发作18年,加重伴双下肢浮肿1月余入院.患者既往有冠心病:陈旧性广泛前壁、下壁心肌梗塞,缺血性心肌病,心律失常、心房纤颤,入院后考虑为慢性充血性心力衰竭,即给予静脉点滴硝普钠,12.5pg/min,静点前病人排尿顺利,既往也无前列腺肥大增生病史,静点后约6h病人自觉下腹胀疼,有尿意,但出现排尿困难,查体下腹部叩诊为实音,确定有膀胱充     

Persistent proatlantal intersegmental artery and occipital artery originating from internal carotid artery

Summary A case of a combined anomaly of persistent hypoglossal and proatlantal intersegmental arteries, proved on arteriogram obtained by the insertion of a needle into the common trunk of both arteries, is presented. In addition, a case of anomalous occipital artery arising from the internal carotid artery associated with an intracranial aneurysm and arteriovenous malformation is presented. Based upon analysis of the persistent proatlantal intersegmental artery and the anomalous occipital artery, we conclude that both arteries have an identical embryological origin.     

血管内支架治疗颈动脉及椎动脉狭窄的20例临床分析

目的探讨血管内支架治疗颈动脉及椎动脉狭窄的安全性及有效性。资料与方法对20例颈、椎动脉狭窄行颈动脉球囊扩张及支架成形术(CAS)治疗的患者作回顾性分析,对临床表现、治疗方法及治疗前后的影像资料改变进行分析。结果 20例患者行CAS治疗,共成功放置支架22枚,11例采用颈动脉保护装置。术前干预血管平均狭窄度(76.2±11.4)%,术后支架膨胀不满意采用球囊后扩者3例。术后造影显示15例残余狭窄度<10%,4例<20%,仅1例<38%,术后平均狭窄度(12.4±8.2)%。治疗前后狭窄度比较有显著统计学意义(P<0.001)。随访平均(12.3±5.6)个月,7例支架术后6个月发现支架有不同程度再狭窄,但再狭窄率均未超过30%,均无神经系统症状。结论血管内支架治疗颈动脉及椎动脉狭窄是安全和有效的,近期随访无严重再狭窄(>50%)及颅内严重并发症发生。     

肾动脉支架成形术两种置入途径的疗效比较

 目的 对比经肱动脉和经股动脉途径行肾动脉支架成形术(percutaneous transluminal renal artery stenting,PTRAS)安全性及有效性。方法 回顾性分析132例接受PTRAS的肾动脉狭窄(renal artery stenosis,RAS)患者,比较经肱动脉与经股动脉途径完成操作患者的临床资料、介入手术参数及结果。结果 所有入选患者(n=132)术前收缩压(150.72±22.57 )mmHg与术后收缩压(136.67±20.43)mmHg相比明显下降,差异具有统计学意义(t=4.974, P<0.01);术前舒张压(81.46±12.19)mmHg与术后舒张压(76.52±10.45) mmHg相比也有明显下降,差异有统计学意义(t=4.418, P<0.01)。术后6个月所有入选患者门诊随访收缩压(132.20±20.42)mmHg与术前相比明显下降,差异有统计学意义(t=18.523, P<0.01);门诊随访舒张压(74.22±10.57)mmHg与术前相比明显下降,差异有统计学意义(t=7.242, P<0.01)。两组靶病变狭窄程度、平均支架长度、平均置入支架直径、穿刺部位出血并发症、平均手术时间、造影剂用量比较,差异均无统计学意义(P>0.05)。结论 行PTRAS时,肱动脉途径是股动脉途径有效替代方式。     

经桡动脉路径椎动脉支架成形术的临床研究

目的评价经桡动脉行椎动脉支架成形术的安全性及有效性,主要优缺点及适应证、禁忌证,并探讨其技术要点。方法对36例不适合经股动脉路径行椎动脉支架成形术或不愿意术后卧床的患者进行经桡动脉椎动脉支架成形术(桡动脉组),统计其穿刺成功率、手术成功率及并发症发生率;并与同期52例经股动脉椎动脉支架成形术(股动脉组)结果进行比较。结果穿刺成功率、手术成功率及并发症发生率在桡动脉组分别为97.2%(35/36)、88.9%(32/36)、5.6%(2/36),股动脉组分别为98.1%(51/52)、96.2%(50/52)、26.9%(14/52)。两组间穿刺成功率、手术成功率差异无统计学意义(χ2=0.09378,0.8087,P值均>0.05);但并发症发生率两组间差异有统计学意义(χ2=5.17,P<0.05)。桡动脉组患者发生穿刺部位轻微淤血2例,无血肿、假性动脉瘤和动静脉瘘等严重并发症发生。结论经桡动脉椎动脉支架成形术安全有效,并发症发生率低,可作为椎动脉支架成形术的选择途径之一。     

Missed Total Occlusion Due to the Occipital Artery Arising from the Internal Carotid Artery

A 56-year-old man was referred for digital subtraction angiography (DSA) with an ultrasound diagnosis of right proximal internal carotid artery (ICA) stenosis for possible carotid artery stenting. DSA revealed total occlusion of the ICA and an occipital artery arising from the stump and simulating continuation of the ICA. An ascending pharyngeal artery also arose from the same occipital artery. This case is of interest because this is a rare variation besides being a cause of misdiagnosis at carotid ultrasound.     

非支气管动脉与支气管动脉联合双重栓塞治疗大咯血

目的 探讨非支气管动脉与支气管动脉联合双重栓塞治疗大咯血的临床应用价值.方法 21例急性大咯血患者,行支气管动脉与非支气管动脉(包括肋间动脉、胸廓内动脉、胸上动脉、肩胛下动脉、隔动脉等)造影,并对异常血管用PVA颗粒、明胶海绵和/或钢圈双重栓塞.结果 21例大咯血患者,共栓塞74支异常血管.其中支气管动脉32支,肋间动脉22支、胸廓内动脉9支,胸上动脉6支,膈动脉3支、肩胛下动脉2支.术后即刻止血14例,咳血量明显减少5例,有所减少2例,即刻止血率及总有效率分别为71.4％、100％.无严重并发症发生.结论 在行支气管动脉栓塞治疗咯血时,同时仔细寻找并栓塞参与供血的非支气管动脉有重要的临床意义,能提高疗效,降低复发.     

Rare carotid-vertebrobasilar anastomoses with notes on the differentiation between proatlantal and hypoglossal arteries

Summary Two cases of persistent anastomoses between the carotid and vertebrobasilar systems which have only once been previously reported are described. These are a proatlantal intersegmental artery which arises from the external carotid artery and a primitive trigeminal artery with direct anastomosis to the superior cerebellar artery. Angiographic criteria for differentiation of the proatlantal and more common hypoglossal arteries, as well as the rare persistent cervical intersegmental artery are also presented.     

Anatomical Variations of the Popliteal Artery and its Tibial Branches: Analysis in 1242 Extremities

The purpose of this study was to analyze the variations in branching of the popliteal artery by reviewing femoral arteriograms. Between 2004 and 2006, digital subtraction angiographies of both lower extremities were performed in 621 patients. We reviewed these 1242 arteriograms retrospectively in order to analyze the branching pattern of the popliteal artery. Of the 1242 extremities, 1108 extremities (89.2%) had normal branching pattern of the popliteal artery. The remaining 134 extremities (10.8%; 65 right, 69 left) in 105 patients (66 men, 39 women; 76 unilateral, 29 bilateral) showed seven variant branching patterns: hypoplastic or aplastic posterior tibial artery (PT) (n = 63, 5.1%); hypoplastic or aplastic anterior tibial artery (AT) (n = 21, 1.7%); trifurcation (n = 19, 1.5%); high origin of AT (n = 15, 1.2%); hypoplastic or aplastic PT and AT (n = 10, 0.8%); high origin of PT (n = 5, 0.4%); and anterior tibioperoneal trunk (n = 1, 0.1%). When the branching pattern of the popliteal artery is normal in one extremity, there is a 13% probability the other side will be a variant pattern. When the branching pattern is variant in one extremity, there is a 28% probability the opposite side will also contain a variation. Variations in branching of the popliteal artery are not uncommon. Awareness of these variations is important for evaluation of the lower extremity arteriograms and has clinical implications for vascular surgeons and interventional radiologists.     

Transarterial chemoembolization of hepatocellular carcinoma via extrahepatic collateral artery from a supraduodenal and cystic artery trunk,originating from the gastroduodenal artery: A case report

The outcome of transarterial chemoembolization for unresectable hepatocellular carcinoma (HCC) relies on the appropriate identification of tumor supplying arteries. HCC derives 90% of the blood supply from the hepatic arteries. However, depending on the tumor''s size and location, the extrahepatic collateral artery (EHC) can develop and predominantly supply the tumor. The supraduodenal artery (SDA) arises from the gastroduodenal artery (GDA). On the other hand, the cystic artery (CA) mostly originates from the right hepatic artery. However, a common trunk of the SDA and CA originating from the GDA and feeding the HCC as an EHC has not been reported. We herein present a 76-year-old man with HCC in segment 6, supplied by an EHC from a common trunk of the SDA and CA originating from the GDA. Selective arteriography confirmed the EHC, which was successfully embolized with drug-eluting beads without complications.     

Percutaneous transluminal angioplasty of an innominate artery occlusion

A middle-aged woman presented with recent-onset left hemiparesis and right subclavian steal syndrome. She was found to have an obstructed innominate artery. We successfully performed balloon angioplasty of the occluded innominate artery and encountered no complications during follow-up of currently 8 months.