Fragmentation hemolysis in idiopathic hypertrophic subaortic stenosis

A 69-year-old woman with previously asymptomatic IHSS developed fragmentation hemolytic anemia in association with bacterial endocarditis when the calculated pressure gradient across the left ventricular outflow tract was 82 mm Hg. Partial correction of the anemia by transfusion resulted in a prompt reduction in fragmentation. The interplay of anemia and increased pressure gradient in the production of red cell fragmentation is discussed.     

ECG characteristics in patients with idiopathic hypertrophic subaortic stenosis

The ECG data on 111 patients aged 2-61 years with idiopathic hypertrophic subaortal stenosis are provided. Of these, 18 patients were examined over time (during 1 to 6 years). The ECG data were considered depending on the clinical disease progress, the patients' age, and the intracardiac and echocardiographic findings.     

Parachute mitral valve: Echocardiographic findings resembling idiopathic hypertrophic subaortic stenosis

The echocardiographic features recorded in a patient with a congenital anomaly, single papillary muscle (parachute mitral valve), were identical with those seen in patients with idiopathic hypertrophic subaortic stenosis (IHSS). Asymmetric septal hypertrophy, mitrai valve systolic anterior movement, aortic valve vibration, and midsystolic reclosure were all demonstrated. This congenital anomaly should, therefore, be considered in any young paitent before making the diagnosis of IHSS from the echocardiogram.     

Systolic anterior motion of the tricuspid valve in idiopathic hypertrophic subaortic stenosis.

A 37 year man with combined subpulmonic and subaortic idiopathic hypertrophic stenosis proved by cardiac catheterization had typical echocardiographic findings of idiopathic hypertropic subaortic stenosis (IHSS) and systolic anterior motion of the anterior leaflet of the tricuspid valve. This motion of the tricuspid valve may relate to the subpulmonic infundibular gradient in the same way that the systolic anterior motion of the anterior mitral leaflet relates to the subaortic left ventricular gradient in patients with IHSS.     

Echocardiographic pseudoidiopathic hypertrophic subaortic stenosis in a patient with pericardial effusion.

A 26 year old white male with chronic renal failure presented to our institution with a large pericardial effusion. In addition to the effusion, an echocardiogram demonstrated systolic anterior movement of the anterior leaflet of the mitral valve (SAM), suggesting idiopathic hypertrophic subaortic stenosis (IH-S). Pericardiectomy was performed to treat the effusion. After surgery and relief of the effusion, the mitral valve motion returned to normal. It is concluded that SAM can be seen with pericardial effusion in the absence of IHSS.     

气管内插管用于无痛食管超声内镜检查103例临床应用体会

目的 对气管内插管用于无痛食管超声内镜检查的有效性、安全性等进行临床评价.方法 采用靶控榆注瑞芬太尼及异丙酚、琥珀胆碱依次静脉注射进行气管内插管、人工机械通气,检查中瑞芬太尼及异丙酚维持麻醉至检查结束.结果 所有病例均顺利完成检查,检查过程中血压、心率、脉搏氧饱和度(SPO2)稳定,患者术中无知晓,检查结束苏醒迅速;患者及内镜检查医师均对麻醉效果满意.结论 静脉快速诱导气管内插管、人工机械通气、全凭静脉麻醉用于食管超声内镜检查是一种安全、有效、可行的麻醉方法.     

腹腔镜胆囊大部切除术的临床应用体会(附468例报告)

目的探讨腹腔镜胆囊大部切除术的适应证及临床应用体会。方法回顾性分析2012年1月-2015年12月解放军第451医院因无法行腹腔镜胆囊切除术而改为胆囊大部切除术的临床病例资料468例。结果术后无死亡病例发生。7例行腹腔镜胆囊切除术中转开腹胆囊大部切除术,5例Mirizzi综合征(I型3例,II型2例)和456例(各种原因导致的三角区粘连)行腹腔镜胆囊大部切除术。术后无严重并发症出现,16例出现胆瘘,2例十二指肠瘘,适当引流后均痊愈。362例随访时间(21.0±4.9)个月,消化不良18例,右上腹或上腹部不适11例。结论对于胆囊三角区粘连严重的胆结石患者,腹腔镜下胆囊大部切除术是安全可行的,可避免对胆道的损伤,术中和术后重点观察患者胆瘘情况。     

胰岛素瘤的诊断与治疗(附103例分析)

目的 :探讨胰岛素瘤的合理诊断及治疗方法。方法 :对我科 1966～ 2 0 0 3年外科治疗的 10 3例胰岛素瘤病人进行回顾性分析。据Whipple三联症、B超、CT、胰岛素释放指数等方法对胰岛素瘤进行诊断。病理检查结果作为胰岛素瘤的最后诊断。结果 :87%的患者具有Whipple三联症 ;术前B超、CT及术中B超对肿瘤的正确诊断率分别为 3 0 %、45 %、98%;测定胰岛素释放指数的患者均大于 0 4,97%的患者术后低血糖症状消失。结论 :Whipple三联症、胰岛素释放指数 (IRI/G) >0 4可作为定性诊断的重要依据 ,术中B超有助于肿瘤的发现 ,手术是治疗胰岛素瘤的有效方法