正向入口不明CTO病变的处理策略和器械技术

正冠状动脉慢性完全闭塞(CTO)病变是指严重的冠状动脉内粥样斑块负荷,导致冠状动脉内血流阻断即心肌梗死溶栓(TIMI)血流0级,达到完全或几乎完全闭塞的确定或已知持续时间超过3个月的病变[1,2]。CTO病变是一种常见的冠状动脉复杂病变,约占全部经皮冠状动脉介入治疗(PCI)病例的10%～20%[3]。CTO病变以较低的手术成功率著称,相     

冠状动脉慢性完全闭塞病变开通价值的研究进展

正冠状动脉慢性完全闭塞病变(CTO)指冠状动脉完全闭塞超过3个月、TIMI血流0级的病变,发生率约占冠状动脉造影确诊为冠状动脉粥样硬化性心脏病(冠心病)患者的20%~30%[1],仅8%~15%的患者接受经皮冠状动脉介入治疗(PCI)。CTO发病率和接受PCI的比例呈明显反差,一方面是CTO治疗难度大,成功率低,术后并发症发生率高。研究报道在技术成熟的诊疗中心或丰富经验的介入专家,CTO患     

血管内超声指导导丝通过技术开通冠状动脉慢性闭塞性病变

<正>慢性完全闭塞(CTO)病变患者约占全部冠状动脉(冠脉)造影(CAG)阳性患者的1/3,如果经皮冠脉介入治疗(PCI)成功开通CTO病变血管,可缓解患者的心绞痛症状、改善左心室收缩功能、减少冠脉搭桥手术及增加生存率[1-2]。但CTO接受PCI者仅占全部PCI病例的10%~15%,原因是CTO病变PCI技术难度大、即刻成功率低、术后再闭塞和再狭窄发生率高,被认为是目前PCI领域最     

冠状动脉慢性完全闭塞病变研究最新进展

<正>冠状动脉慢性完全闭塞病变(chronic total occlusion,CTO)是指,闭塞时间>3个月的病变。CTO病变约占全部冠状动脉造影的30%以上,目前接受经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)者<8%,仅占全部PCI病例的10%～20%,与非闭塞冠状动脉病变相比,[1-2]     

反向CART技术治疗冠状动脉慢性完全闭塞病变

慢性完伞闭塞(chronic total occlusion,CTO)病变是指冠状动脉完全闭塞且闭塞时间超过3个月的病变.经皮冠状动脉介入治疗(PCI)是治疗CTO病变有效方式之一.但PCI手术失败最常见的原因是导丝不能通过CTO而进入血管远端真腔[1].逆向PCI技术是提高开通CTO成功率较为有效的方法[2-5].     

冠状动脉慢性完全闭塞病变的临床研究进展

<正>冠状动脉慢性完全闭塞(chronic total occlusion,CTO)病变迄今是冠状动脉疾病(coronary artery disease)领域研究的重点和难点,更是冠心病介入治疗领域需要攻克的"堡垒"。循征医学数据显示,目前CTO病变介入治疗的平均病变成功率为75.1%(62%~85%),而随着医疗器械的发展和冠心病PCI水平的不断提高,CTO病变PCI成功率可达     

从循证视角看冠状动脉慢性完全闭塞病变的内外科治疗

w@@ 冠状动脉慢性完全闭塞病变(claronic total occlusion,CTO))通常是指冠状动脉闭塞超过3个月的病变,约占全部冠状动脉造影病例的1/3 和全部经皮冠状动脉介入治疗(PCI)病例的10%～20%.     

冠状动脉慢性完全闭塞病变病理生理机制和血运重建策略

<正>冠状动脉慢性完全闭塞(chronic total occlusion,CTO)是指冠状动脉管腔100%闭塞、前向TIMI血流0级,且持续时间3个月以上(少数情况下,同侧桥侧支形成,使阻塞远端TIMI血流0级,也属CTO范畴)。冠状动脉造影证实冠心病患者中,约20%存在CTO[1]。CTO病变已成为经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)领域中需要     

冠状动脉分叉病变介入治疗中分支血管闭塞风险评估

<正>冠状动脉分叉病变是经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)中的常见病变,约占PCI治疗总量的15%~20%[1]。冠心病分叉病变介入治疗对术者技术要求高,介入治疗所需时间长,且介入治疗过程中的分支血管闭塞等导致严重后果。冠心病分叉病变介入治疗过程中的分支血管闭塞发生率约为6%~19%[2~4]。分支血管闭塞会引起心     

慢性完全闭塞冠状动脉病变介入治疗的现状与挑战

冠状动脉慢性完全闭塞病变(CTO)是指冠状动脉100%闭塞且闭塞超过3个月的病变[1].CTO行经皮冠状动脉介入治疗(PCI)技术难度大、即刻成功率低、术后再闭塞和再狭窄发生率高,故被认为是目前PCI领域最大的障碍和挑战.近年来通过各国心脏介入专家的广泛交流与合作,在CTO专用器械研发、PCI手术技巧等方面都取得了很大的进展.     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.