川崎病临床特征与猝死--附2例报告并文献复习

目的探讨川崎病的临床特征与猝死机制。方法收集2例经法医病理学尸检证实的川崎病猝死的病例资料,回顾分析其临床特征与猝死机制。结栗此2例惠儿,1男1女,年龄分别为1岁和3岁,均因其它不适在输液过程中突然死亡,之前2周有发热,皮肤红斑,尸检证实2例猝死患者均并发冠状动脉瘤,瘤腔内血栓形成。结论川崎病临床特征不典型,早期诊治是防治因并发冠状动脉瘤而猝死的关键。     

川崎病并发心血管损害

心脏和冠状动脉受累多发生于起病1～6周。心血管病变主要涉及全身中、小动脉及心脏,尤其是冠状动脉多被侵犯,可形成冠状动脉扩张、冠状动脉瘤、心包炎与心包积液、 全身动脉(腋、髂、肾)瘤,如冠状动脉瘤发生钙化、狭窄或血栓,可导致心肌梗死甚至猝死。可幸的是严重的冠脉后遗症低,在川崎病病人约2～3％,一旦发生心肌梗死,死亡率相当高,在第一次梗死时达22％,因此必须经外科治疗阻止早期死亡,以改善生活质     

Bentall术治疗主动脉根部病变6例分析

主动脉根部瘤样扩张和主动脉夹层是常见的主动脉根部病变,二者常引起主动脉瓣关闭不全,而瘤体及急性夹层的破裂是患者猝死的主要原因[1]。由于主动脉根部病变涉及升主动脉、冠状动脉及主动脉瓣,给外科治疗带来很大的困难。     

川崎病32例临床分析

川崎病是一种非特异性全身血管炎性改变的疾病。80％发病在5岁以下,男：女为1．5：1。其发病趋势逐年上升,未经治疗其冠状动脉瘤的发病率可达15％-25％。川崎病并发冠状动脉瘤可造成冠状动脉狭窄,引起缺血性心脏病导致心肌梗死和猝死,成为该病死亡的主要原因。我们对32例川崎病住院患儿临床表现、心血管系统的并发症及大剂量静脉注射丙种球蛋白治疗且长期随访的结果报告如下。     

68例川崎病临床分析

川崎病(Kawasaki disease,KD)是一种病因不明的急性发热、出疹性疾病,其基本病理改变为全身性血管炎。它主要侵犯大、中血管,其中冠状动脉血管炎引起的冠状动脉瘤和冠状动脉狭窄最为严重,可导致缺血性心脏病、心肌梗死和猝死。本文综合分析68例KD患儿临床资料,以期发现对早期诊断有价值的临床特征。     

免疫系统异常在川崎病发病中的作用

川崎病(ｋａｗａｓａｋｉ ｄｉｓｅａｓｅ ＫＤ)是一种病因未明的小儿急性弥漫性血管炎综合征,本病呈自限性,临床特点为急性发热、皮肤粘膜病损和淋巴结肿大。约２０%的病人可伴发冠状动脉损害,如冠状动脉瘤、动脉扩张或狭窄,部分病人可发生冠状动脉局部出血、心肌梗死甚至猝死。目前认为本病是小儿后天性心脏病的主要原因之一,也是成人冠状动脉疾病的     

丙种球蛋白治疗川崎病的观察及护理

川崎病是小儿时期的一种急性全身性血管炎,病变主要累及心血管系统,尤其是冠状动脉,可引起冠脉扩张、冠脉瘤、血栓栓塞,导致心肌梗死而猝死.现将丙种球蛋白治疗川崎病的观察及护理简述如下.     

川畸病并发冠状动脉病变的相关因素分析

川畸病是一种急性发热出疹性疾病,好发于婴幼儿,７５％在４岁以下发病。是一种原因不明的全身血管炎,主要侵犯中小动脉,特别是冠状动脉,形成冠状动脉瘤,引起血栓性梗塞狭窄导致心肌梗塞、猝死。冠状动脉瘤发生率２０％～３０％,约１％～２％患儿于发病头３个月内死...     

冠状动脉狭窄与猝死关系分析

目的：分析冠状动脉狭窄与猝死关系。方法：对2005~2009年内蒙古医学院法医系接收的66例尸检病理资料进行分析。结果：猝死案例以30~50岁男性为主,有39例。无明显诱因猝死23例,有明显诱因猝死28例。冠状动脉粥样硬化Ⅰ~Ⅱ级狭窄者23例,Ⅱ~Ⅲ级狭窄者19例,Ⅲ~Ⅳ级狭窄者24例。其中左前降支狭窄最多,其次为右冠状动脉、左旋支。陈旧性心肌梗死（OMI）27例,急性心肌梗塞（AMI）14例,OMI和AMI混合存在15例。结论：猝死中冠状动脉狭窄占有很大比例,存在狭窄者大部分都有不同程度的心肌梗死。所以平素健康人群也需要预防冠状动脉粥样硬化狭窄,高危人群应做检查（如超声心动图、MDCT、冠状动脉造影）,排除冠状动脉狭窄,避免意外的发生。     

不典型川崎病的早期诊断

川崎病（KD）于1967年由日本川崎富作首先报告,曾称为粘膜皮肤淋巴结综合征,是一种病因不明确的儿童常见的自身免疫性血管炎综合征。其主要病理改变为全身非特异性血管炎,累及中小血管特别是冠状动脉，可形成冠状动脉瘤，引起血栓性梗塞、狭窄，导致心肌梗死、猝死。目前KD已取代风湿热成为儿童后天性心脏病的主要原因，其中不典型川崎病也随之增多。     

Study of sudden cardiac deaths in young athletes

Sudden cardiac deaths in athletes are usually due to underlying cardiovascular disease. The final pathway is usually ventricular fibrillation following hypertrophic cardiomyopathy and coronary artery anomalies in young persons below the age of 30 years. Sudden cardiac death in young is rare but remains as a source of concern. A postmortem study was conducted to ascertain the cardiac causes of sudden death in persons below the age group 30 years following exercise in games or otherwise. Out of 15 cases in autopsy finding, hypertrophic cardiomyopathy (n=7) was the commonest cause followed by coronary artery anomalies (n=4). Sudden unexpected death is a source of concern and careful screening of history and physical examination for potential athletes should identify majority of people at risk.     

无痛型主动脉夹层动脉瘤破裂死亡一例的误诊分析

[背景 ]无痛型主动脉夹层动脉瘤罕见 ,在临床上易误诊 ,常需进行尸检确定 .[病例报告 ]以头晕、双下肢乏力 ,偶伴有胸闷、气急为主诉而入院的老年患者 1例 ,入院诊断为I级高血压、冠状动脉性心脏病、心律不齐、脑梗死 ,给予降压、扩冠、对症等治疗 .入院第 3d在卫生间突然死亡 ,通过尸检发现死因为主动脉夹层动脉瘤破裂 .[讨论 ]主动脉夹层动脉瘤破裂主要通过尸检分析确诊 ,但也可通过进行彩色B型超声波、CT、核磁共振检查来减少误诊 .     

Rare complications of a low lying median arcuate coeliac ligament

Pancreaticoduodenal artery aneurysm is a rare complication of coeliac artery stenosis secondary to a low lying median arcuate coeliac ligament. This article reports the case of a 69-year old man who presented with left arm and leg weakness, clinically in keeping with right hemisphere stroke. Initial CT brain scan was within normal limits. The patient did not receive thrombolysis as he was outside the time window. 3 hours later the patient experienced sudden onset epigastric pain and acute shock. CT aorta abdominal was diagnostic of a ruptured inferior pancreaticoduodenal artery aneurysm. Repeat CT brain the following day showed subacute infarction within the right frontal lobe. Embolisation of the aneurysm was successfully performed. It is well documented that ischaemic stroke can cause acute hypertension. This acute hypertension probably contributed to the rupture of the pancreaticoduodenal artery aneurysm. The patient was well on discharge and remains well 2 months on.     

Giant cell arteritis (temporal arteritis, cranial arteritis) and a case from Singapore

Giant cell arteritis as the underlying cause of blindness in the elderly is common in the West but is not seen except on rare occasions in South East Asia. We describe an 86-year-old Chinese man from Singapore who presented with a central retinal artery occlusion. Biopsy of a prominent superficial temporal artery established the underlying cause to be giant cell arteritis which was also the eventual cause of death as the condition resulted in rupture of a dissecting aneurysm of the aorta. Giant cell arteritis should be considered in all cases of ischaemic eye disease in the elderly. The importance of early diagnosis lies in the very high incidence of second eye involvement within days or at most weeks in untreated patients. A high index of suspicion is required for diagnosis of this condition which is likely under-diagnosed in our local context.     

1例绝经后女性在心理应激后发生冠状动脉自发夹层的病例报道

冠状动脉自发夹层(SCAD)是引起急性心肌梗死的少见原因之一,其病因及发病机制目前均尚未明确.大多数SCAD发生于年轻患者及女性患者.本文我们报道了1例52岁绝经后健康女性,其在心理应激后发生SCAD,后者引起急性心肌梗死,最终导致左心室室壁瘤形成.我们希望本例报道可加深理解SCAD这一少见疾病,并提醒临床医师对绝经后女性发生急性胸痛做出诊断时,应更加关注其心理健康状况.     

Causes of sudden cardiac death in young Australians

OBJECTIVES: To determine the causes of sudden cardiac death in people aged 35 years or younger. DESIGN AND SETTING: A review of all autopsies performed between 1 January 1994 and 31 December 2002 at a major Sydney forensic medicine department serving an area with over 2 million people. MAIN OUTCOME MEASURES: Incidence of various types of cardiac disease causing sudden death in those aged 相似文献   

Sudden death in young Aboriginal adults with rheumatic heart disease

A retrospective review for the period 1983 to 1988 was made of all sudden deaths in young Aboriginal adults from the Darwin and East Arnhem regions who had known rheumatic heart disease. A total of five cases was identified from autopsy reports. The age range was between 16 and 35 years. All were being treated for asymptomatic heart disease (grade I). The sudden, unexpected death in each of these patients resulted in their deaths all being reported to the coroner. In all cases there was no evidence at autopsy of significant coronary artery disease or bacterial endocarditis. All had evidence of rheumatic valvular heart disease affecting either one or both mitral and aortic valves to varying degrees. No other cause of death was found. This report serves to illustrate the fact that rheumatic heart disease is still a significant contributor to morbidity and mortality in Aborigines, and that while the usual picture of progressive deterioration in exercise tolerance may be the norm, sudden death without any apparent preceding symptomatology can occur.     

Sudden cardiac death in Air Force recruits. A 20-year review

We reviewed the clinical and autopsy records of the 19 sudden cardiac deaths that occurred among the 1,606,167 US Air Force healthy, medically screened recruits (90% male; 17 to 28 years old) during a 42-day basic training period between 1965 and 1985. Sixteen (all male) died suddenly of underlying structural heart disease, whereas no anatomic cause of death was identified in the remaining three. Thirty-two nonsudden, noncardiac deaths occurred during the same period, and only two had structural heart disease. Strenuous physical exertion was associated with sudden death in 17 of 19 cases (0.017 deaths per 50,000 exercise-hours), and the most frequent underlying etiology was myocarditis. Sudden cardiac death, a rare event in healthy young adults, is usually associated with exertion.     

Bilateral persistent sciatic arteries with unilateral complicating aneurysm

Persistent sciatic artery is a very uncommon embryological vascular variant. This case report highlights this rare vascular anomaly, diagnostic difficulty, complication and subsequent treatment in a 43-year-old man who presented with sudden onset of right leg pain for a few hours. He was unable to walk because of pain and numbness. Emergency right lower limb angiogram showed a large aneurysm that was initially thought to arise from the right common femoral artery, associated with thrombus formation within the right popliteal artery. A below knee amputation was performed due to worsening ischaemia of the right leg. The persistent right sciatic artery was later obliterated using percutaneous stenting and endovascular grafting, with deployment of two wallstents.