亚急性Stanford B型主动脉夹层腔内隔绝术后瘤体重构分析

目的:探讨亚急性主动脉夹层腔内隔绝术后瘤体重构的特点。方法:回顾性分析我科1998年9月至2005年10月43例亚急性主动脉夹层腔内隔绝术后随访影像学资料。将主动脉分为S1、S2、S3三段,设定每段主动脉中点所在平面为观察横断面,分别测量每次随访CT各观察横断面真、假腔及瘤体直径,观察其变化情况。结果:术后12个月内S1、S2瘤体及真假腔重构变化较明显,真腔直径逐渐增大、假腔血栓化吸收、瘤体逐渐减小,24个月后变化趋于稳定,而S3段在术后重构变化不显著。结论:亚急性主动脉夹层腔内隔绝术安全有效,术后瘤体重构满意。病人在度过急性期后应尽早行腔内隔绝术,使得瘤体得到较好重构,尽量恢复至发病前状态。     

伽玛刀治疗后并发症的临床病例分析

目的 总结伽玛刀治疗后并发症的临床发展规律和神经影像学特点,探讨其易发因素和可能的发生机制。方法 随访伽玛刀治疗后的动静脉畸形(AVM)、脑膜瘤、生殖细胞瘤、神经胶质细胞瘤、颅内转移瘤5种疾病共253例患者,总结分析急性期、亚急性期和晚期并发症的发生率以及靶组织的细胞增殖速度,AVM和脑膜瘤的病灶部位与并发症发生率的关系。结果 5种疾病的并发症均多发生在亚急性期。晚反应组织和早反应组织、AVM中心型和周边型、脑膜瘤颅底型和非颅底型相比,亚急性期并发症发生率均有显著性差异。结论 伽玛刀治疗引起的并发症多发生在亚急性期。多数急性期并发症具有自限性。放射线晚反应组织的亚急性期并发症发生率高于早反应组织。AVM和脑膜瘤的亚急性期并发症发生率与病灶部位有关。     

PKP治疗不同时期骨质疏松性椎体压缩骨折的结果比较

目的探讨经皮椎体后凸成形术（percutaneous kyphoplasty,PKP）对不同时期骨质疏松骨折患者的疗效,从而探讨PKP治疗骨质疏松椎体骨折的最佳手术时机。方法回顾性分析2008年9月至2011年9月随机接受PKP治疗的106例患者,按照骨折至接受PKP时间分为急性期组、亚急性期组和慢性期组,于不同时间点通过视觉模拟疼痛评分（visual analogue scale,VAS）、骨水泥渗漏率确定各组疗效。结果急性期组、亚急性期组术后24h及术后3个月VAS评分与术前比较差异有统计学意义（P〈0.05）,慢性期组术后24h VAS评分与术前比较差异无统计学意义（P〉0.05）,随访至术后3个月时差异有统计学意义（P〈0.05）。骨水泥总渗漏率16.3%,其中亚急性组4.4%,较急性期组的17.6%及慢性期组的21.2%差异有统计学意义（P〈0.05）。结论 PKP是一种治疗老年骨质疏松椎体压缩骨折有效的微创方法,选择急性期或亚急性期治疗效果更优,尤其是亚急性期骨水泥渗漏率最低。选择慢性期行PKP治疗仍可获得一定远期疗效,但要注意其有着较高的骨水泥渗漏风险。     

Amplatz血栓消融术治疗大块肺栓塞——附2例报告

目的 探讨Amplatz血栓消融器治疗大块肺栓塞(PE)的可行性。方法 对2例年轻男性经溶栓无效或贻误有效溶栓时机的大块PE患者行Amplatz血栓消融术。结果 术后肺血流灌注亚急性PE患者明显改善,慢性PE再发患者略有改善。前者PaQ2由术前53．8mmHg升至67．3mmHg,2个月后升至80．0mmHg。7个月后核素肺灌注显像大致正常。后者术中症状明显减轻,术后PaO2由66．4mmHg升至83．6mmHg。3个月后,肺动脉压由53．5mmHg降至24mmHg。仅1例术中轻微左侧胸痛。结论 对大块亚急性PE患者实施Amplatz血栓消融术技术上可行,但需进一步评价。     

Case of symptomatic subacute in-stent thrombosis after carotid angioplasty and stenting for severe carotid stenosis

We report a case of symptomatic subacute in-stent thrombosis after carotid artery angioplasty and stenting (CAS). The patient was a 72-year-old man who had severe asymptomatic right carotid artery stenosis. He received CAS with distal protection, and gained 100% opening of the right carotid artery. The administration of dual antiplatelet therapy (Aspirin 100 mg/day+Cilostazol 100 mg/day), which had been given since two weeks before the procedure, was continued afterwords. On the seventh day after the stent placement, the patient showed sudden onset of left hemiparesis and conjugated deviation of both eyes to the right side and followed by falling into a comatose state. Emergency angiography showed near occlusion of the right carotid artery, suggesting subacute in-stent thrombosis. In conjunction with the intravenous administration of tissue plasminogen activator (1300,000 IU), we performed additional stent placement on the stented portion of the ICA and gained full recanalization of the ICA about three hours after the onset of the symptoms. The patient showed rapid recovery and returned home with slight clumsiness of his right hand. Symptomatic subacute in-stent thrombosis after CAS is a rather rare complication. We discuss on the possible cause of this and stress the necessity of an additional emergency stenting to gain rapid recanalization.     

Nonoperative treatment of acute hamate hook fractures.

Six patients with acute and two patients with subacute nondisplaced fractures of the hamate hook were treated with immobilization. The patients with acute fractures were treated within 7 days of the injury, and those with subacute fractures were treated after 7 days. Seven of the eight patients showed documented healing of their fractures. At follow-up (average 8 months) all seven were free of symptoms. One patient with a subacute fracture did not comply with treatment and had a painful nonunion. Our results show that hamate hook fractures that are diagnosed early may heal with nonoperative management. Fractures that fail to heal with immobilization or those with chronic nonunion should be treated with excision of the hook fragment.     

The adult form of subacute necrotizing encephalopathy

The rare adult form of subacute necrotizing encephalopathy in a 49-year-old man is reported. Six months before admission the previously healthy and nonalcoholic patient developed progressive hemiparesis of the left side and instability of gait. Ventriculography revealed marked narrowing of the aqueduct, and after ventriculocisternotomy the patient became akinetic and mute. The postmortem histologic examination revealed pathologic changes characteristic of subacute necrotizing encephalopathy. This case demonstrates that this rare disease in an adult may cause both akinetic mutism and aqueductal stenosis.     

Left ventricular pseudoaneurysm after sutureless repair of subacute left ventricular free wall rupture: a case report.

A 65-year-old woman presenting with a left ventricular pseudoaneurysm 27 months after sutureless repair of a subacute left ventricular free wall rupture complicating acute myocardial infarction is described. An autologous pericardial patch and gelatin resorcin formaldehyde (GRF) glue were used in the repair. A small pseudoaneurysm bulged out over the true aneurysm of the left ventricle. We performed a Dor operation and concomitant bypass grafting to the right coronary artery. Although sutureless repair is an effective procedure for subacute left ventricular free wall rupture, left ventricular pseudoaneurysm in the late postoperative period may be a rare problem after this repair.     

Time-related changes in the cerebral blood flow in subarachnoid hemorrhage due to ruptured cerebral aneurysm]

Cerebral blood flow (CBF) was determined by the 123I-IMP SPECT reference sample method in 39 patients with subarachnoid hemorrhage (SAH) due to ruptured cerebral aneurysm. They were examined according to the time lapse after onset, severity, CT findings, and prognosis. These 39 patients were admitted to our medical center within 36 hours after the onset, and SAH and ruptured aneurysm were diagnosed by CT scan and angiography, respectively. Patients with intraventricular hemorrhage, intracerebral hematoma, and other severe complications were excluded. The stage of SAH was divided into three, by designating the day of onset as day 0: day 0-4 as the acute stage, day 5-20 as the subacute stage, and day 21 and after that as the chronic stage. Acute stage surgery was conducted within 48 hours after the onset on principle. Hyperdynamic therapy and cisternal drainage were conducted in severe case of SAH. The prognosis was evaluated with Glasgow outcome scale (GOS). The average CBF was 33.39, 29.44, and 33.15 in the acute, subacute, and chronic stages, respectively. These are values lower than the reference sample value, 43.39 (ml/100 g/min). Only a small number of cases, however, revealed vasospasm by angiography conducted in the acute stage. There was a correlation between the CT severity in the acute stage and the decrease in CBF. In the group with low density area (LDA) on CT due to delayed cerebral ischemia in the subacute stage, the average CBF was 28.28 and 23.95 in the acute and subacute stages, respectively. These values were significantly lower than 35.97 and 32.45, respectively, in the group without LDA.(ABSTRACT TRUNCATED AT 250 WORDS)     

Subacute massive pulmonary embolism treated with plasminogen and streptokinase

Major pulmonary embolism occurring insidiously over several weeks (subacute massive pulmonary embolism) has a high mortality and may not respond well to standard anticoagulant or thrombolytic treatment. A priming dose of plasminogen was used to enhance thrombolysis produced by a streptokinase infusion in five consecutive patients with subacute massive pulmonary embolism. In each patient a dramatic clinical improvement occurred with a substantial increase in pulmonary blood flow. All five patients survived to leave hospital. Malignant disease was the underlying cause of embolism in three patients, two of whom died of their malignant disease in the six months after treatment of their pulmonary embolism. The third patient with malignant disease had a choriocarcinoma; at least some of the pulmonary obstruction may have been tumour tissue but this obstruction was dramatically cleared by the treatment. The use of a combination of plasminogen with streptokinase should be considered in severely ill patients with subacute massive pulmonary embolism, particularly if other treatment, including streptokinase alone, has failed.     

Subacute osteomyelitis of the tibial diaphysis associated with Brodie's abscess: A rare case report of a four-year-old child

IntroductionSeptic osteomyelitis is a hematogenous bacterial bone infection. The acute presentation is the most common; the subacute one is less frequent. The aim of our case report is to put forward the features of this uncommon presentation and to propose a therapeutic management.Presentation of caseWe report a rare case of subacute osteomyelitis associated with Brodie's abscess of the tibial diaphysis in a four-year-old child. The chief complaint was a pain in the left tibia evolving for five weeks. The radiological findings and the unusual location of this pathology suggested a malignant bone tumor. Thanks to imaging assessment and bone biopsy the diagnosis of subacute osteomyelitis associated with Brodie's abscess was made. Therefore, the child had antibiotic therapy and plaster immobilization to avoid pathological fracture. Pain relief and radiological improvement was obtained after 3 months of antibiotic treatment. At a two-year follow-up, the X-ray was normal.DiscussionWe report an uncommon case of subacute osteomyelitis which evolved to Brodie's abscess with diaphyseal location. The mainstream treatment is surgery combined with antibiotics. However, medical treatment alone can lead to recovery without sequelae.ConclusionBecause of the atypical location and presentation of subacute osteomyelitis, the other differential diagnoses, especially malignant bone tumors have to be eliminated. In some cases, treatment may be based on antibiotics therapy alone.     

Oxidative stress in rat kidneys due to 3,4-methylenedioxymetamphetamine (ecstasy) toxicity

AIM: The mechanism of MDMA (3,4-methylenedioxymethamphetamine)-induced toxicity is believed to be, in part, due to enhanced oxidative stress. As MDMA is eliminated via the kidney, the aim of this study was to investigate whether MDMA created conditions of oxidative stress within rat kidney. METHODS: Adult male Wistar rats were divided into three groups, control treatment (water), acute MDMA administration (single oral dose: 5, 10, 20 or 40 mg/kg body weight) and subacute MDMA administration (5, 10, or 20 mg/kg body weight per day during 14 days). Animals were sacrificed 8 h after the single oral MDMA administration in the acute MDMA administration group and after the last MDMA administration in the subacute MDMA administration group. Rectal temperature measurements, oxidative stress status parameters and histological examinations were performed. RESULTS: In all MDMA-administered rats, rectal temperature markedly increased peaking approximately 1 h after MDMA ingestion. Superoxide dismutase activity and thiobarbituric acid reactive substances increased after MDMA administration. Histological examinations of the kidney revealed dose-dependent disruption of tissue structure in subacute MDMA-administered rats. The latter was not observed in acute MDMA-administered rats.     

Clinical profile of subdural hematomas: dangerousness of subdural subacute hematoma

Subacute subdural hematomas are a poorly individualized nosological entity, often equated clinically to chronic subdural hematomas. Yet, their neurological deterioration which is usually rapid seems to distinguish them from chronic subdural hematomas. We wanted to show this dangerousness by establishing the clinically evolving profile of the three types of subdural hematomas. This was a prospective and retrospective study of 63 subdural hematoma (18 acute, 13 subacute, and 32 chronic) patients admitted between 2012 and 2014 in the neurosurgery unit of Lomé University Hospital. Hematomas were classified according to the elapsed time after head injury and blood density on CT. The main parameter studied was the evolution of the Glasgow Coma Score (GCS) in the 3 months following the trauma, enabling to establish an evolving profile of each type of hematoma. The average age of patients was 58.1 years for chronic subdural hematomas and 47.6 years for subacute subdural hematomas. Disease duration before admission was 13.1 days for chronic against 36.6 h for subacute hematoma. The clinical profile shows acute worsening within hours during the second week for patients with subacute hematoma, while it is progressive for patients with chronic hematoma. We noted two deaths, all victims of a subacute hematoma (one operated, one patient waiting for surgery). Iso-density hematoma on CT, especially in a young person, must be considered as a predictive factor of rapid neurological aggravation suggesting an urgent care or increased monitoring by paramedics.     

超声对泼尼松治疗亚急性甲状腺炎停药指标的判断价值

目的探讨二维超声结合彩色多普勒血流显像（CDFI）对亚急性甲状腺炎的诊断价值和泼尼松停用指标的判断。方法66例亚急性甲状腺炎患者应用二维超声结合CDFI效应动态观察甲状腺声像图,在使用泼尼松治疗后,随机分为超声观察停药组36例和临床症状停药组30例,观察两组复发情况。结果声像图主要表现为病灶区回声减低,CDFI示病变周边血流较丰富,病灶内动脉血流特点为低速低阻型。超声观察停药组复发率8．33％（3／36）,明显低于临床症状停药组的26．67％（8／30）,两组比较差异有统计学意义（P〈0．05）。结论二维超声结合CDFI可以诊断和指导亚急性甲状腺炎的治疗,为病情评价提供客观依据。     

早期软组织覆盖成形在重度开放性胫骨骨折治疗中的作用

目的　研究早期软组织覆盖成形在重度开放性胫骨骨折治疗中的作用。　方法　Ⅲb型开放性胫骨骨折 76侧按软组织覆盖成形的时间不同分为三组。早期 (0～ 7d) 31侧 ,中期 (8～ 30d)2 4侧 ,晚期 (>30d) 2 1侧。比较各组感染、骨不愈合等并发症的发病率和平均骨折愈合时间。　结果　早期软组织覆盖成形组深部感染、骨折不愈合等并发症的发生率 (6 5 % ,12 9% )明显低于中、晚期组 (5 0 0 %、47 6 %和 37 5 %、38 1% ) ,平均骨折愈合时间 (5 0周 )少于中、晚期组 (78周和 82周 )。　结论　早期软组织覆盖成形可明显减少重度开放性胫骨骨折的并发症 ,缩短骨愈合时间。“早期”应尽量限于 1周内 ,1周后医源性感染的机会将会增加。     

Reversible acute and subacute myelopathy in patients with dural arteriovenous fistulas. Foix-Alajouanine syndrome reconsidered

Acute or subacute neurological deterioration without evidence of hemorrhage in a patient with a spinal arteriovenous (AV) malformation has been referred to as "Foix-Alajouanine syndrome." This clinical entity has been considered to be the result of progressive vascular thrombosis resulting in a necrotic myelopathy; it has therefore been thought to be largely irreversible and hence untreatable. The authors report five patients with dural AV fistulas who presented in this manner, and who improved substantially after embolic and surgical therapy. The outcome of these patients indicates that acute and subacute progression of myelopathy in cases of spinal dural AV fistulas may be caused by venous congestion and not necessarily by thrombosis. Therefore, a clinical diagnosis of Foix-Alajouanine syndrome is of little practical use, as spinal cord dysfunction from venous congestion is a potentially reversible process whereas thrombotic infarction is not. This diagnosis may result in suboptimal management. The recognition of nonhemorrhagic acute or subacute myelopathy as a complication of a spinal dural AV fistula is important since what appears to be irreversible cord injury is often treatable by standard surgical techniques.     

Subacute bacterial endocarditis causing disseminated intravascular coagulation: resolution after valve replacement

The following report describes a case of culture-negative subacute bacterial endocarditis complicated by disseminated intravascular coagulation which failed to respond to therapy with antibiotics and heparin. The coagulopathy resolved within 24 hours after the affected heart valves were replaced with prosthetic valves.     

Changes in Outcomes after Discharge from an Acute Hospital in Severe Traumatic Brain Injury

Neurological improvement occurs from the subacute to chronic phases in severe traumatic brain injury. We analyzed factors associated with improved neurological findings in the subacute phase, using data from the Japan Neurotrauma Data Bank (JNTDB). The subjects were 1345 patients registered in the JNTDB (Project 2015). Clinical improvement was evaluated by comparing the Glasgow Outcome Scale (GOS) at discharge and 6 months after injury. Of these patients, 157 with severe disability (SD) on the discharge GOS were examined to evaluate factors associated with neurological improvement in the subacute phase. Cases were defined as those with (group I) and without (group N) improvement: a change from SD at discharge to good recovery (GR) or moderate disability (MD) at 6 months after injury. Patient background, admission findings, treatment, and discharge destination were examined. In all patients, the favorable outcome (GR, MD) rate improved from 30.2% at discharge to 35.7% at 6 months after injury. Of SD cases at discharge, 44.6% had a favorable outcome at 6 months (group I). Patients in group I were significantly younger, and had a significantly lower D-dimer level in initial blood tests and a lower incidence of convulsions. In multivariate analysis, discharge to home was a significant factor associated with an improved outcome. Many SD cases at discharge ultimately showed neurological improvement, and the initial D-dimer level may be a predictor of such improvement. The environment after discharge from an acute care hospital may also contribute to an improved long-term prognosis.     

Biochemical changes after surgical stress in rabbits

Biochemical changes in blood, i.e. glucose, ketone bodies, lactate, protein, blood urea nitrogen (BUN), and free alanine before and after surgical stress were measured in normal and diabetic rabbits. Both the normal and diabetic rabbits were divided into two groups; the acute phase (0 to 180 minutes after surgery) and the subacute phase (1 to 3 postoperative days). Surgical stress was induced by performing laparotomy under anesthesia. Glucose, ketones, lactate, BUN, and alanine were higher in diabetic than normal animals. Protein level was lower in the diabetics. In the acute phase, normal and diabetic animals showed a similar reaction. In the subacute phase, ketone bodies and BUN increased predominantly in normal animals with no change of glucose levels. In two of the diabetics, an increase in glucose, lactate and alanine was seen. These phenomena support Bessman's postulation of stress which has two phases, the catecholamine phase and the pituitary-adrenal phase. It is considered that this reaction to surgical stress in the acute phase is due to glycogenolysis i.e., glucose from glycogen and lipolysis i.e., ketones from fat induced by catecholamine, and that increased ketone bodies and glucose levels in the subacute phase are due to ketogenesis i.e., ketones from protein and gluconeogenesis i.e., glucose from protein. In both phases ketonemia is predominant in normal rabbits after surgical stress, suggesting that insulin does not reduce directly lipolysis in the acute phase and ketogenesis in the subacute phase, under conditions of stress.     

Polybacterial pyomyositis following laparoscopic colectomy for complicated diverticulosis

We report a case of diffuse subacute muscle infection caused by enteric bacteria, diagnosed two months after laparoscopic colectomy for a sigmoid abscess and successfully treated with antibiotics alone.