腹直肌鞘血肿的诊断与治疗

目的：探讨腹直肌鞘血肿的诊断与治疗方法。方法：回顾性分析RSH患者12例,男4例,女8例,年龄37~81岁,平均年龄60.6岁,其中接受抗凝治疗5例,抗血小板治疗2例。分析患者症状、体征、血肿解剖特点、辅助检查、治疗方法及预后。结果：12例RSH中位于上腹部4例、下腹部8例。10例有突发腹痛症状,11例可触及腹壁包块并明显压痛。12例行腹部CT平扫均正确诊断,其中Ⅰ型血肿8例、Ⅱ型2例、Ⅲ型2例。11例患者保守治疗后血肿吸收,1例经保守治疗血肿液化后行穿刺引流术,血肿完全吸收。结论：RSH常见于老年人,尤其是接受抗凝、抗血小板治疗的患者,临床多表现为突发腹痛并腹壁包块,CT检查有助于早期明确诊断,保守治疗多能取得良好效果。     

Spontaneous rectus sheath hematomas: clinical and radiological features

We reviewed the clinical and radiological features in eight patients with spontaneous rectus sheath hematoma (RSH). The diagnosis was confirmed at surgery in four patients, and spontaneous resolution occurred in the other four. All patients were elderly adults. Acute abdominal pain and a palpable mass after muscular strain, such as coughing or twisting, were features highly suggestive of RSH. Sonographically, these hematomas may be confused with abdominal wall tumors. On CT scans, a hyperdense mass posterior to the rectus abdominis muscle with ipsilateral anterolateral muscular enlargement is considered characteristic of acute RSH, although chronic RSH may be isodense or hypodense relative to the surrounding muscle. MRI is very useful in the diagnosis of RSH, which is demonstrated as a high signal intensity area on both T1- and T2-weighted images, especially when the CT findings are not specific for RSH. Received: 16 August 1994/Accepted: 3 October 1994     

Atraumatic splenic rupture in a patient treated with rivaroxaban: A case report and a narrative review

Atraumatic splenic rupture (ASR) is a rare condition mostly associated with neoplastic, infectious, and inflammatory diseases. ASR associated with drug treatment is even rarer. In this case report, we highlight an unusual complication of the direct oral anticoagulant rivaroxaban. A 64‐year‐old male patient was admitted to the emergency department with complaints of faintness and diffuse abdominal cramps. The patient had no history of recent trauma. Clinical examination revealed hemodynamic instability with a moderate response to filling and mild abdominal discomfort on palpation. His medical history included chronic hypertension, constipation, and recent atrial flutter ablation. The patient was taking amiodarone, bisoprolol, atorvastatin, and rivaroxaban. Splenic rupture was diagnosed several hours later on contrast‐enhanced abdominal computed tomography scan. Massive blood transfusions and emergency laparotomy for splenectomy were performed. Anatomopathological analysis did not reveal any neoplastic, inflammatory, or infectious causes. The patient was successfully discharged from the intensive care unit 3 days later. Clinicians must consider the possibility of ASR as a complication of rivaroxaban in patients with abdominal tenderness and hemodynamic instability. Unfortunately, clinical presentation is not always typical of a ruptured spleen. Delayed diagnosis can be life threatening or fatal. Splenectomy via laparotomy remains the best therapeutic option in cases of splenic rupture in unstable patients on direct oral anticoagulants.     

双眼外直肌后徙术与单眼外直肌后徙术+内直肌缩短术治疗基本型间歇性外斜视患儿的比较研究

目的分析双眼外直肌后徙术(bilateral lateral rectus recession,BLR-rec)与单眼外直肌后徙术+内直肌缩短术(unilateral分析双眼外直肌后徙术(bilateral lateral rectus recession,BLR-rec)与单眼外直肌后徙术内直肌缩短术(unilateral recess-resect,R&R)在基本型间歇性外斜视患儿中的应用效果。方法选取我院基本型间歇性外斜视患儿98例,依照手术方选取我院基本型间歇性外斜视患儿例,依照手术方案不同分为BLR组(n=49)、RR组(n=49),BLR组采用BLR-rec,RR组采用R&R。统计比较两组手术效果。结果RR组组手术过矫4.08%、正矫85.71%、欠矫10.20%情况与BLR组10.20%、83.67%、6.12%比较,差异无统计学意义(P>0.05);RR组立体视功能提高69.39%、不变18.37%、降低12.24%情况与BLR组73.47%、16.33%、10.20%比较,差异无统计学意义(P>0.05);术后6个月、12个月RR组视近、视远斜视度高于BLR组(P<0.05);RR组复发率2.50%低于BLR组20.51%(P<0.05)。结论BLR-rec与R&R治疗基本型间歇性外斜视患儿均具有良好疗效,R&R受内直肌功能状态影响远期疗效稳定BLR-rec受内直肌功能状态影响远期疗效稳定性较BLR-rec差,但R&R复发率低于BLR-rec,因此,临床可根据患儿内直肌功能状态选择适宜术式。     

Anticoagulant therapy with rivaroxaban in a young patient with paroxysmal nocturnal hemoglobinuria

The new direct oral anticoagulants such us rivaroxaban, could play an important role in the anticoagulant treatment of patients with paroxysmal nocturnal hemoglobinuria where anticoagulant treatment is complex to run, since they have shown a reduction in serious bleeding complications compared to antithrombotic therapy with classical vitamin k antagonist.     

Oral rivaroxaban after symptomatic venous thromboembolism: the continued treatment study (EINSTEIN-Extension study)

Over recent years, research on anticoagulant drugs has been guided by the requirement for convenient administration and a wide therapeutic window to allow fixed dosing without the need for coagulation monitoring. Rivaroxaban is the first of a new class of anticoagulant drugs, the direct, selective inhibitors of Factor Xa. The EINSTEIN-Extension study compared rivaroxaban with placebo in patients who completed their standard treatment course after venous thromboembolism (VTE), in whom there was equipoise with respect to the need for continued anticoagulation. After 6–12 months of treatment, rivaroxaban significantly reduced the risk of recurrent VTE at the cost of a moderate increase in bleeding complications. Overall, these results suggest that rivaroxaban can be a valid alternative to warfarin for patients requiring long-term secondary prevention of VTE. However, additional data are needed for special populations including the elderly, patients with cancer, renally impaired patients and morbidly obese patients, all of whom were scarcely represented in this trial.     

Favorable therapeutic index of the direct factor Xa inhibitors, apixaban and rivaroxaban, compared with the thrombin inhibitor dabigatran in rabbits

Summary.  Background: Apixaban is an oral, direct factor Xa (FXa) inhibitor in late-stage clinical development. This study assessed effects of the direct FXa inhibitors, apixaban and rivaroxaban, vs. the direct thrombin inhibitor, dabigatran, on venous thrombosis (VT), bleeding time (BT) and clotting times in rabbits. Methods: We induced the formation of non-occlusive thrombus in VT models by placing threads in the vena cava, and induced bleeding by the incision of cuticles in anesthetized rabbits. Apixaban, rivaroxaban and dabigatran were infused IV to achieve a stable plasma level. Clotting times, including the activated partial thromboplastin time (aPTT), prothrombin time (PT), modified PT (mPT) and thrombin time (TT), were measured. Results: Apixaban, rivaroxaban and dabigatran exhibited dose-related efficacy in preventing VT with EC₅₀ of 65, 33 and 194 n m , respectively. At doses for 80% reduction of control thrombus, apixaban, rivaroxaban and dabigatran prolonged BT by 1.13 ± 0.02-, 1.9 ± 0.1-* and 4.4 ± 0.4-fold*, respectively (* P  <   0.05, vs. apixaban). In the treatment model, these inhibitors equally prevented growth of a preformed thrombus. Antithrombotic doses of apixaban and rivaroxaban prolonged aPTT and PT by <3-fold with no effect on TT. Dabigatran was ≥50-fold more potent in prolonging TT than aPTT and PT. Of the clotting assays studied, apixaban, rivaroxaban and dabigatran responded the best to mPT. Conclusion: Comparable antithrombotic efficacy was observed between apixaban, rivaroxaban and dabigatran in the prevention and treatment of VT in rabbits. Apixaban and rivaroxaban exhibited lower BT compared with dabigatran at equivalent antithrombotic doses. The clinical significance of these findings remains to be determined.     

Anticoagulation with rivaroxaban: covering a broad spectrum of thromboembolic disease

Traditional anticoagulants such as heparin and vitamin K antagonists have been the mainstay of antithrombotic therapy for many years. However, these drugs have a number of well-recognized drawbacks: unfractionated heparin, low molecular weight heparins and fondaparinux are administered parenterally, and vitamin K antagonists require routine coagulation monitoring. Novel, single-target oral anticoagulants have been developed that do not need routine coagulation monitoring, including the direct factor Xa inhibitors rivaroxaban, apixaban and edoxaban, and the direct thrombin inhibitor dabigatran. Rivaroxaban is the most advanced in its clinical development. Across all ten Phase III/IV trials, rivaroxaban met the primary efficacy end points and generally had similar incidences of bleeding, with a comparable safety profile to standard-of-care.     

Ultrasound-guided rectus sheath block for anterior cutaneous nerve entrapment syndrome after laparoscopic surgery: A case report

BACKGROUNDAnterior cutaneous nerve entrapment syndrome is defined as abdominal pain due to entrapped intercostal nerves. This is the first report of a patient successfully treated for anterior cutaneous nerve entrapment syndrome after laparoscopic surgery with an ultrasound-guided rectus sheath block. The rectus sheath block physically lysed adhesions and relieved pain from anterior cutaneous nerve entrapment syndrome.CASE SUMMARYThe patient is a 44-year-old man who presented with severe left upper abdominal pain at an operative scar one month after laparoscopic ulcer repair. Diagnosis and treatment were performed using an ultrasound-guided rectus sheath block with 0.1% lidocaine 20 mL. The pain was relieved after the block. The diagnosis was anterior cutaneous nerve entrapment syndrome. Rectus sheath block may be effective for patients with anterior cutaneous nerve entrapment syndrome.CONCLUSIONUltrasound-guided rectus sheath block is a promising treatment modality for patients with postoperative anterior cutaneous nerve entrapment syndrome due to adhesions.     

Rectus sheath hematoma in COVID‐19 patient: The importance of abdominal pain in the course of COVID‐19

We report herein a case of a 58‐year‐old woman with COVID‐19. During the hospitalization, the patient complained of acute abdominal pain, and abdominal CT revealed the rectus sheath hematoma (RSH). Since corticosteroids and anti‐coagulation are commonly administered in COVID‐19 patients, physicians should consider RSH as a possible diagnosis for acute abdominal pain.     

Spontaneous hemothorax caused by concomitant low-dose rivaroxaban and itraconazole in a 95-year-old patient: case report and literature review

Although direct-acting oral anticoagulants (DOACs) decrease the bleeding risk compared with vitamin K antagonists (VKAs), DOACs might cause spontaneous hemothorax in very elderly patients, even at a very low dose. Interactions between drugs might increase the risk of bleeding. In this article, we report a case of a 95-year-old man who developed spontaneous hemothorax while taking rivaroxaban 2.5 mg twice daily, 3 days after concomitant use of itraconazole. Rivaroxaban was discontinued, and thoracentesis was performed to drain grossly bloody pleural effusion. To our knowledge, this is the first case report of spontaneous hemothorax that might have been caused by concomitant low-dose rivaroxaban and azole anti-fungal agents. This case highlights the potential risk of spontaneous hemothorax in very elderly patients while taking rivaroxaban and azole anti-fungal agents simultaneously. Special attention should be paid to interactions between drugs that might increase the risk of bleeding. Drugs that have competing metabolic pathways should be avoided. Closer monitoring, including testing for anti-Xa and additional reassessment, should be considered in high-risk patients.     

高频超声在腹直肌肌皮瓣转移修复胸壁放射性溃疡中的应用价值

目的探讨术前运用高分辨率彩色多普勒血流成像技术（CDFI）检测腹壁上、下血管对腹直肌肌皮瓣覆盖胸壁放射性溃疡的价值。方法16例乳癌放疗术后胸壁放射性溃疡患者行胸部溃疡切除、腹直肌肌皮瓣转移术。术前用以CDFI探查双侧腹壁上、下动脉位置、走行，以二维超声检测双侧腹壁上、下动脉的管腔内径，同时以脉冲多普勒分段测血管收缩最大血流速度。结果16例32根腹壁上、下动脉均成功检测，腹壁上动脉均存在不同程度的损伤，血管出现走行变异、管腔变窄等表现，并为手术证实。结论术前使用彩色超声血管检查仪对腹壁上、下动脉主干及其肌皮穿支检测，有利于筛选手术适应证和选择肌皮瓣的血供类型，同时可指导肌皮瓣设计和确定术中腹直肌前鞘切开游离部位。