起搏电极嵌入三尖瓣腱索1例报告

<正> 患男,56岁,因反复发作胸闷、气憋、头晕、眼前黑蒙两年余,晕厥1次于1992年5月11日急诊收入院。查体:一般情况尚可,能平卧。口唇微发绀,心音低钝,以第一心音为著,心率36次/min,律不齐,心尖部可闻及Ⅱ级收缩期杂音,较柔和,双肺呼吸音清,未闻及干湿性罗音,肝脾未触及,双下肢不水肿。入院时心电图示:窦性心律,二度Ⅱ型房室传导阻滞,R—R间期长达1.68s,T波低平,TV_5倒置呈冠状T改变,血三脂:胆固醇6.5mmol/L,甘油三脂2.     

外伤性三尖瓣关闭不全外科治疗：附1例报告

外伤性三尖瓣关闭不全是一种较为罕见的后天性心脏病，多继发于严重的胸部外伤，右心衰为其主要的临床特征。1991～1998年国内文献检索到5例，我院于1997年6月收住1例，并成功地施行了手术，现报道如下。1病例介绍患者，男性，14岁。4年前因车祸致闭合性胸、腹联合伤，肝胃破裂，在当地医院作肝、胃修补术，术后1周出现胸闷、心悸、腹胀及下肢水肿，经X线胸片及B型超声心动图证实：左胸心包积液、腹水，疑三尖瓣解索断裂伤。经反复穿刺抽液、强心、利尿等治疗，上述症状缓解，伤口愈合出院。之后反复出现活动后心悸、水肿，近半年来症状明…     

功能性三尖瓣关闭不全的外科治疗

目的探讨32例功能性三尖瓣关闭不全(TI)的手术方法及近期疗效。方法22例风湿性心瓣膜病、10例先心病合并功能性Ⅱ，采用De Vega环缩术24例、改良De Vega分段成形术7例、Kay’s二瓣叶化成形8例。结果1例De Vega成形术患者术后11d因纵隔感染死亡，其余患者均痊愈出院。随访1个月至3．5年，平均1．8年。2例术前重度Ⅱ行De Vega成形术患者，术后有轻度反流，1年后复查超声反流无加重，1例行De Vega成形术患者术后2年发生三尖瓣轻度反流。结论积极的处理功能性TI，有助于患者术后心功能的改善，提高其生活质量。常用的De Vega环缩术、改良De Vega分段成形术、Kay’s二瓣叶化成形术具有操作简单、费用便宜、近期疗效满意的特点。其远期疗效有待进一步随访观察。     

继发性三尖瓣关闭不全的外科治疗

目的:探讨继发性三尖瓣关闭不全的外科治疗方法。方法:总结1998年1月至2003年6月收治的128例中、重度继发性三尖瓣关闭不全的临床资料。结果:128例患者死亡4例存活124例患者术后1～2周心脏彩超检查三尖瓣关闭不全全部消失101例,占81.45%;术后仍有轻、中度三尖瓣关闭不全23例占18.55%。结论:Kay’s二瓣叶化成形术和DeVega成形术均为治疗继发性三尖瓣关闭不全的有效方法。     

继发性三尖瓣关闭不全的外科治疗

目的探讨继发性三尖瓣关闭不全的外科治疗方法.方法总结1998年1月至2003年6月收治的128例中、重度继发性三尖瓣关闭不全的临床资料.结果128例患者死亡4例,存活124例患者术后1～2周心脏彩超检查,三尖瓣关闭不全全部消失101例,占81.45%;术后仍有轻、中度三尖瓣关闭不全23例,占18.55%.结论Kay's二瓣叶化成形术和DeVega成形术均为治疗继发性三尖瓣关闭不全的有效方法.     

中、重度功能性三尖瓣关闭不全的外科治疗

目的三尖瓣成形环成形术对功能性三尖瓣关闭不全的临床疗效评价。方法 2008年6月至2011年6月对60例中度至重度功能性三尖瓣关闭不全的患者行三尖瓣成形手术,进行分组,其中30例采用传统Devega法成形术(A组);30例采用国产佰仁思瓣膜成形软环(B组),于术后2周、6个月、12个月进行随访;分析对比两组的成形效果。结果两组患者早期三尖瓣反流差异无统计学意义。手术后6个月、12个月进行随访,A组和B组在三尖瓣反流方面,两组间差异有统计学意义(P<0.01)。结论三尖瓣成形环治疗功能性三尖瓣反流方面具有较好的中、远期效果。     

三尖瓣关闭不全的外科治疗

目的探讨三尖瓣关闭不全（TI）外科治疗的手术特点、方法和疗效。方法 2000年1月~2009年2月,我院行手术治疗TI患者262例,其中器质性TI 16例,功能性TI 246例,手术采用三尖瓣成形术（TVP）257例,三尖瓣置换术（TVR）5例。结果术后早期死亡10例,手术病死率为3.82%。术后随访116例,平均随访时间（31.5±11.1）个月。远期死亡3例,余113例远期存活者心功能Ⅰ级者23例,Ⅱ级者71例,Ⅲ级者15例,Ⅳ级者4例。结论无论是器质性或功能性TI,多数可以行TVP,对无法行成形术的患者应行TVR。右心衰竭与心律失常是三尖瓣手术早期和晚期死亡的重要原因,围手术期应加强右心功能的维护和心律失常的防治。     

三尖瓣关闭不全的外科手术治疗

目的探讨三尖瓣关闭（TI）不全外科治疗的手术特点、方法和疗效。方法行手术治疗的262例TI病人中,器质性TI16例,功能性TI246例,采用三尖瓣成形术（TVP）257例,三尖瓣置换术（TVR）5例。结果术后早期死亡10例,手术死亡率为3．82％。术后随访116倒,平均随访（31．5±11．1）个月。远期死亡3例,远期存活113例中心功能Ⅰ级23例,Ⅱ级71例,Ⅲ级15例,Ⅳ级4例。结论无论是器质性或功能性TI,多数可以行TVP,对无法行成形术的病例应行TVR。右心衰竭与心律失常是三尖辫手术早期和晚期死亡的重要原因,围手术期应加强右心功能的维护和心律失常的防治。     

Endolymphatic sac papillary tumor: a case report

Endolymphatic sac papillary tumor (ELST) is an extremely rare and aggressive tumor characterized by hearing loss and temporal bone destruction. A case with clinical, imaging, pathologic and treatment data is reported and relevant literature is reviewed. A 25-year-old woman, with ELST underwent craniotomy for tumor subtotal resection, and the diagnosis was confirmed by pathologic examination. Postoperative radiotherapy consisted of 50.4 Gy/28 f was given accordingly. The patient is currently alive with no signs of tumor recurrence locally and no radiation side-effects observed after one year follow-up. Complete resection is impossible in most cases, local resection, adjuvant radiotherapy may provide favored local control. A long-term follow-up is highly advocated in consideration of its slow development course.

     

Traumatic diaphragmatic hernia associated with pelvic fractures： a case report and literature review

Objective： To review the epidemiological feature, clinical, and diagnostic data of post-traumatic diaphragmatic hernia （TDH） associated with pelvic fractures patients reported in recent 10 years. Methods： One case of delayed presentation of TDH after pelvic fractures taken place one month later was present, with a review on the literature of this kind of patients in our country. Results： The incidence of TDH associated with pelvic fractures was relatively rare, and the diagnosis were often delayed or missed. Although the trans-thorax approach was preferred for surgical closure in the acute phase, its mortality was 8.51%. Conclusion： TDH associated with pelvic fractures is difficult to diagnose because of their varied clinical and radiological signs and the patients may not present with symptoms for a long time following the injury. In clinical, a high index of suspicion with appropriate examination is the mainstays of management, which can also increase the prognosis.     

Thyroid gland papillary carcinoma with fibromatosis-like stroma: case report

Papillary carcinoma of the thyroid may show a variable degree of fibrosis of the stroma, but proliferation of the stromal fibroblasts mimicking fibromatosis is rare. There appears to be a new variant of papillary carcinoma of the thyroid associated with exuberant proliferation of the fibroblasts resembling fibromatosis. We present one such case in a 50 year old woman and succinctly reviewed the relevant literature of this rare variant. The necessity of a diligent search for a papillary carcinoma in thyroid gland which shows a proliferative fibrous lesion is stressed.     

Traumatic panniculitis of the right thigh: a case report

Panniculitis is a group of diseases whose hallmark is inflammation of the subcutaneous adipose tissue that may be challenging both for the clinician and the dermatopathologist. It can occur in any fatty tissue (cutaneous or visceral) and is often diagnosed on the basis of a deep skin biopsy. Though mesenteric panniculitis is a common entity, and often associated with intra-abdominal inflammatory conditions, cutaneous panniculitis is a rare entity and can be mistaken for other skin and subcuteneous lesions. We present a patient with traumatic panniculitis.     

Diagnosis of E. coli tricuspid valve endocarditis: a case report

Escherichia coli is a rare cause of bacterial endocarditis. We report a case of an elderly man with cirrhosis who developed bacterial endocarditis due to E.coli. We review the literature that summarizes a total of 41 cases, with a predominance of elderly women, diabetics, and patients with urinary tract infections and prosthetic heart valves. E.coli bacteremia may be mistakenly attributed to a more benign source such as urosepsis and overlooked as an indication of endocarditis. A delay in diagnosis may lead to higher mortality as the opportunity for early valve replacement in appropriate cases and more prolonged courses of antibiotics may not be considered.