脑出血患者心电图异常改变193例分析

目的　拟对 193例颅内出血急性期心电图异常改变的分析 ,预测患者病情的预后。方法　对经CT证实的脑出血急性期检测的心电图有异常改变的患者进行跟踪分析研究。结果　本组心电图有异常改变的患者 193例 ,死亡 35例 ,治愈或好转 158例。多表现为J波、ST段抬高或下移及恶性室性心律失常。结论　脑出血急性期心电图的异常改变大部分可随着脑部病变的好转而逐渐恢复 ,一旦出现一过性ST段抬高、J波、并伴有恶性室性心律失常 ,提示预后不佳     

Electrocardiographic changes in tetanus: a serial study.

Serial electrocardiograms (ECGs) were recorded in 20 consecutive male patients admitted to the Infectious Diseases Hospital, Calcutta with generalised tetanus. Age of patients varied from 5 to 40 years (mean age 20.4 years). Ten patients died. ECGs were recorded daily for the first week after admission and later every 2nd or 3rd day. Altogether, 167 ECGs were analysed. Sinus tachycardia was present in 17 (85%) patients, prolonged QT interval in 12 (60%) patients, non-specific ST-T abnormalities in 12 (60%) patients and P wave changes in 10 (50%) patients. Other abnormalities recorded, included short PR interval, supraventricular tachycardia, intraventricular conduction delay, sinus bradycardia, 1 degree A-V block, abnormal axis deviation, right ventricular hypertrophy and sino-atrial Wenckebach phenomenon, although all of the findings cannot clearly be attributed to tetanus. Spatial QRS-T angle was calculated in 18 of these patients to determine any possible change in this parameter of prognostic significance. Two out of 9 who survived had abnormally wide (greater than or equal to 55 degrees) spatial QRS-T angle on admission; the angle narrowed with recovery. In the non-survivor group, 4 patients had abnormally wide QRS-T angles on admission; further widening was noted in patients on whom follow-up tracings were available. The difference in spatial QRS-T angle between the survivor and the non-survivor groups was statistically significant (p less than 0.05). Spatial QRS-T angle changes have not been reported in tetanus before. Although non-specific, serial study in individual cases would be useful in assessing prognosis.     

Extended parietal cell vagotomy in the treatment of perforation, hemorrhage and stenosis due to duodenal ulcer.

Ninety-five patients with perforation, hemorrhage or stenosis due to duodenal ulcer were treated by extended parietal cell vagotomy. Postoperative follow-up ranged from 3.5 to 10 years (mean 6 years) in 88 patients (92%) with acute perforation (60), hemorrhage (8) and stenosis (20). There was no operative mortality. Ulcer recurrence was 2.3%. Only one patient (5%) had restenosis and required reoperation. There was no recurrent hemorrhage and there were few long-term complications. According to the Visick classification, 67 patients (76%) belonged to grade I, 13 (14.7%) grade II, 4 (4.5%) grade III, and 4 (4.5%) grade IV. Extended parietal cell vagotomy proved to be safe with excellent results, low ulcer recurrence and few complications. Moreover, recurrent ulcers healed rapidly following medical therapy. The authors believe that extended parietal cell vagotomy should be the treatment of choice for acute perforation, hemorrhage or stenosis due to duodenal ulcer.

     

Use of the Lecompte procedure for ventriculoarterial connection abnormalities in infants and children with congenital heart diseases

Background The Lecompte （REV） procedure is used to correct abnormal ventriculoarterial connections in patients with congenital heart diseases; it avoids the need for an extracardiac conduit for pulmonary outflow tract reconstruction. The present study aimed to investigate effectiveness and criteria of the REV procedure in children with abnormal ventriculoarterial connections. Methods Thirty-eight children （mean age, （2.2±1.7） years; mean weight, （11.5±3.8） kg） with abnormal ventriculoarterial connections who had an REV procedure in our hospital from January 1998 to May 2006 were studied. Only 10 patients had the usual anteropostedor relationship of the two great arteries. The infundibular septum between the two semilunar valves was aggressively resected to enlarge it and construct a straighter left ventricular outflow tract and a wide tunnel between the ventricular septal defect （VSD） and the aorta. Eighteen cases had the original REV procedure; 20 had a modified REV procedure. Results All patients are alive; none developed severe complications. The postoperative right ventricular （RV） to left ventricular （LV） pressure ratio was 0.20-0.45. Five patients had RV dysfunction; 2 patients had a pressure gradient in the RV ventricular outlet of 30.0-34.5 mmHg; 3 cases had a 37.5-47.3 mmHg pressure difference in the RPA. All patients had an RV pressure less than half the systemic pressure. These gradients＇ magnitudes in all patients were consistent with the post-operative RV to LV pressure ratio （P 〈0.05）. During the follow-up （mean, （4.2±0.6） years）, 2 patients had an RPA pressure gradient of 24.0-29.3 mmHg which abated to less than 10 mmHg after two years. Conclusions The REV procedure provides satisfactory short- to medium-term results. It may be superior tO the Rastelli procedure for treating ventriculoarterial connection abnormalities; it allows early, complete anatomic repair and reduces the need for late re-operation, since no extracardiac conduit is needed. Longer f     

Causes of death and long-term prognosis after myocardial infarction in patients with diabetes mellitus.

The long-term prognosis and causes of death of myocardial infarction (MI) in 62 diabetics were studied. The mean follow-up time was 6.2 years, 11 patients died in the acute stage of MI, 9 of them (81.8%) had anterior infarction and their major causes of death were ventricular fibrillation and cardiogenic shock (72.2%). 19 died in the follow-up period, 14 of them (73.68%) had inferior and anterior septal infarction; and most died of reinfarction and sudden death. The cumulative survival rate 1, 2 and 5 years after MI was 80.7%, 71.9% and 57.9%, respectively. The results suggest that treatment and prevention of MI in patients with diabetes be more attentive to prevent ventricular fibrillation and cardiogenic shock during the acute stage and in the later stage more attention should be paid to preventing reinfarction. At any stage of the disease, strict diabetic control is of vital importance.

     

肾上腺结节样肿物并发难治性高血压的手术治疗(附67例报告)

目的探讨肾上腺结节样肿物合并难治性高血压的诊断与外科治疗经验。方法总结67例肾上腺结节样肿物合并难治性高血压患者的发病年龄、临床表现、相关内分泌检查、影像与病理特点以及手术治疗后的相关变化。本组67例,年龄28～63岁,平均37.8岁,均有高血压病史,平均收缩压(196±33)mmHg,平均舒张压(127±15)mmHg。病程5～240个月,平均65.2个月。肾上腺结节样肿物位于左侧37例,右侧26例,双侧4例。血K+﹤3.5mmol/L者43例。肾素-血管紧张素-醛固酮(ACTH)异常60例,3-甲氧基4-羟基扁桃酸(VMA)异常24例,7例内分泌学的检查均正常。CT或MRI显示肾上腺结节样肿物直径0.3～2.0cm。结果本组患者均行腹腔镜患侧肾上腺结节样肿物切除、肾上腺部分切除术或全部切除治疗。病理检查肾上腺皮质结节样增生28例,肾上腺皮质腺瘤39例。术后血钾、24h尿钾、血肾素醛固酮均恢复正常,术后6个月肾上腺皮质腺瘤组平均收缩压为(127±11)mmHg、平均舒张压为(80±7)mmHg,肾上腺皮质增生组平均收缩压为(135±12)mmHg、平均舒张压为(90±9)mmHg,较术前均有明显下降。结论利用腹腔镜手术行患侧肾上腺部分切除术或全部切除治疗肾上腺结节性肿物合并难治性高血压是安全、可行和有效的方法。     

黏多糖病Ⅱ型患者的心脏表现

目的总结黏多糖病Ⅱ型(MPSⅡ型)患者心脏改变的临床特点。方法收集2000年1月一2011年4月确诊的MPSⅡ型患者14例的临床资料,分析心电图(ECG)和超声心动图检查结果。结果 14例患者均为男性,发病年龄1～8(3.8±2.5)岁,明确诊断并完善心脏检查时年龄(9.3±4.6)岁,心脏查体10例(71.4%)有阳性体征,其中9例可闻及心前区杂音。4例(28.6%)心电图不正常,表现为一度房室传导阻滞、右束支传导阻滞或心室肥厚。行超声心动图检查12例,结果异常11例(91.7%),均表现为瓣膜增厚,其中4例(33.3%)各瓣膜均有增厚,6例(50.0%)为主动脉瓣三个瓣叶及二尖瓣前后叶增厚,1例(8.3%)为先天性主动脉瓣二叶瓣畸形伴瓣叶增厚。2例(16.7%)出现重度肺动脉高压,其中1例伴有中等量心包积液。结论 MPSⅡ型患者多数合并心脏损害,主要表现为瓣膜增厚、粘连及功能异常,少部分出现心肌病变、肺动脉高压、房室传导阻滞等异常,其病程隐匿,需严密随诊。     

热毒宁注射液治疗儿童普通型手足口病38例

目的总结急性脑卒中合并肺部感染的临床表现、实验室检查、影像学资料,探讨如何正确诊断卒中相关性肺炎、合理安排检查及合理使用抗生素。方法回顾性分析73例临床诊断急性出血性脑卒中合并肺部感染并在30天内死亡病例的临床资料。结果73例患者中男性41例,女性32例;合并高血压38例,糖尿病10例,慢性肾脏病5例,COPD5例;发热67例,肺部阳性体征30例,46例白细胞总数〉10×10^9／L,65例中性粒细胞〉70％;48例安排胸片检查,胸片异常37例;23例有痰培养或涂片检查,痰培养阳性13例;使用舒普深6例,泰能1例,27例喹喏酮类抗生素,余使用头孢一代或二代抗生素。结论肺部感染是急性出血性脑卒中的常见并发症,在诊断时应重视影像学检查和病原学检查,合理使用抗生素。     

急性脑出血心肌酶与心电图的变化

目的探讨急性脑出血患者心肌酶与心电图的变化及临床意义。方法对120例急性脑出血患者（脑出血组）和60例健康体检者（正常对照组）在人院后测定心肌酶,常规12导联心电图检查并进行动态观察,两组进行比较。结果与正常对照组相比,脑出血组心肌酶显著升高（P〈0．01）;120例急性脑出血患者中98例出现心电图异常改变（占81．7％）,主要表现为心室复极异常、心律失常及类心梗样改变。其中以ST—T改变最为常见,异常心电图死亡率明显高于正常心电图死亡率,以室性心律失常及类心梗样改变死亡率最高。结论脑出血急性期心肌酶升高及心电图异常提示有心肌损害,常系脑心综合征所致,两者的监测对指导临床治疗及评价预后起着重要作用。     

原发性蛛网膜下隙出血患者心电图和肌酸激酶（CK-MB）改变的研究

目的探讨蛛网膜下隙出血（SAH）后患者的心电活动、肌酸激酶（CK-MB）的变化,并比较不同预后患者的差别。方法回顾分析2005年1月~2008年10月入住我院的67例SAH患者出现ECG改变、CK-MB升高的相关临床资料。结果有38例出现ECG改变,发生率为56.71%,其中复极异常28例（73.68%）,传导异常4例（10.53%）,节律异常14例（36.84%）,病理性Q波2例（5.26%）。CK-MB升高的发生率为37.3l%,有ECG异常的SAH患者出现CK-MB升高的概率更高（P〈0.001）。GOS≤3分者EEG改变和CK-MB异常明显高于COS〉3分者。结论SAH后ECG改变以复极异常为主,预后差者ECG和CK-MB改变更明显。     

Left ventricular thrombi after acute myocardial infarction

Two-dimensional echocardiography was utilized in a prospective study to find the incidence, characteristics and natural history of left ventricular thrombus in 50 consecutive patients with acute myocardial infarction. The overall incidence of thrombosis was 14%; 19% in anterior and 5% in inferior infarction. The thrombus was detected at the apex in 4, along the ventricular septum in 2 and at both these sites in one patient. It was observed 3-10 days after the infarction. Thrombus at the ventricular septum, seen in this study, has not been reported previously in acute myocardial infarction. Development of apical and septal thrombi was significantly associated with akinesis of these sites. Only 2 patients with protruding thrombi had systemic embolism. We conclude that the apex as well as the septum are common sites for thrombosis in patients with severe wall motion abnormalities following acute anterior infarction. Careful observation of these sites during echocardiography may reveal thrombi prone for embolization.     

Echocardiographic abnormalities in primary antibody deficiency

Objective: To document cardiac abnormalities secondary to pulmonary disease in primary antibody deficiency. Patients and methods: A cross sectional audit study of patients from a regional immunology centre. Subjects undergoing two dimensional and Doppler transthoracic echocardiography were reviewed. Ventricular dimensions and function, valvular competence, and estimated pulmonary artery pressure were recorded. Data were compared with clinical variables, pulmonary function tests, and thoracic computed tomography data. Results: Nineteen patients with common variable immunodeficiency and one with IgG₂ subclass deficiency were included, mean age at diagnosis 37.5 years, mean estimated diagnostic delay 10.94 years. Left ventricular impairment was found in 15% and right heart dilatation in 20%. Pulmonary hypertension (mean pulmonary artery pressure >25 mm Hg) was found in 45% (9/20), graded as moderate (40–60 mm Hg) in 44% of cases. Pulmonary function was obstructive in 47% (9/19). Fifty five percent of the patients with computed tomography data within the last five years (10/18) had confirmed bronchiectasis. Patients with right heart dilatation and/or moderate pulmonary hypertension (n = 6) had a more prolonged diagnostic delay (p = 0.04) and more severe lung disease. Conclusion: Echocardiographic abnormalities are common in primary antibody deficiency, associated with diagnostic delay and pulmonary complications. Pulmonary hypertension should be considered in those with severe lung disease and can be confirmed by echocardiography.     

Coronary artery bypass graft outcome: the Trinidad and Tobago experience

The study is retrospective review of the demographic, clinical, angiographic, and operative data of the first 205 consecutive CABG operations performed by Caribbean Heart Care at the Eric Williams Medical Sciences Complex (EWMSC), Trinidad and Tobago, between November 1993 and December 1997. The aim of the study was to determine the in-hospital and intermediate-term follow-up results. The mean age of patients was 59 +/- 10 years and 78% were male. Sixty-four per cent were of East Indian descent, whereas 16% were of African descent. Forty-eight per cent of the patients were hypertensive, 46% were diabetic, 33% had hyperlipidaemia, 20% had a recent history of cigarette smoking and 16% were obese. Sixty-five per cent had a positive family history of ischaemic heart disease. The average time interval between angiography and surgery was 2.3 months. At the time of angiography, 63.5% of patients had Canadian Cardiac Society (CCS) class 3 or 4 angina. The mean ejection fraction was 61 +/- 15%. Wall motion abnormalities were seen in 67% of patients. Significant stenoses of the left anterior descending artery, right circumflex artery, circumflex and ramus coronary arteries were present in 91%, 78%, 54% and 5%, respectively. Many patients (67%) had severe diffuse disease on angiography. The mean intensive care stay was 2.2 +/- 0.8 days. In-hospital mortality was 3.9% (8/205). The most frequent post-operative complication was haemorrhage (2.6%). Acute renal failure occurred in 2.1%; pulmonary collapse, 1.6%; stroke, 1% and cardiac arrest, 1%. Both sternal wound infections and systemic sepsis occurred in 0.5%. Intermediate-term follow-up data were obtained for 92% (189/205). The duration of follow-up ranged from 1 to 5 years (mean 3.7 years). During the follow-up period, 7 patients (3.4%) died. Angina severity was reduced from a mean CCS score of 2.61 +/- 0.95 before CABG to 1.22 +/- 0.55 at the time of follow-up (p < 0.0001). Overall 4-year mortality compared favourably with data from international studies. Among survivors, quality of life improved as evidenced by the reduction in the mean angina score.     

100例急性心肌梗死后室壁瘤的诊断与抗凝治疗效果回顾

目的回顾性分析超声心动图诊断急性心肌梗死（AMJ）后室壁瘤（LVA）及抗凝治疗效果,为临床诊断及治疗提供依据。方法选择2006年10月一2012年1o月收治的100例AMi患者为研究对象,经超声心动图诊断LVA及华法林抗凝治疗,观察临床效果。结果100例A川患者应用超声心动图技术诊断为室壁瘤15例,异常室壁为前壁及左室心尖部有10例,占67％,其次为侧壁3例,占20％,下壁2例,占13％。给予华法林口服治疗．发生不稳定心绞痛1例,再发心肌梗死1例,3例出现出血。结论超声心动图诊断LVA是临床首选,应用华法林抗凝治疗效果较好。     

CLINICAL ANALYSIS OF OBSTRUCTIVE SLEEP APNEA SYNDROME WITH ACUTE RESPIRATORY FAILURE

feSUnt6 ObjeCtif POur studier ies coractdristiques cliniques du syndrew on (Ohetructive sleep aprm ) accomwide i' inSUffimnce respiratoire algUe adns ie but d' une reconnaiamnce et d' un traitement Pr4cOCes en cos d' urgence. metL' analyse des caractdristiques cliniques et deS ~mens de labotoire a ate rdalifor chez 9 cos de syndronze on. Anulfots8 oas boiculins et 1 oas fdminin PrdSentent tons une oddity avec BMI moron 44, 97 kg/mZ (45, 25kg/m' dens ie oas fdminin ).L 'age ntopen est d…     

Echocardiographic findings in a contemporary Afro-Caribbean population referred for evaluation of atrial fibrillation or flutter

Atrial fibrillation and/or flutter is the most common and the most significant cardiac arrhythmia in the Caribbean. This study is an attempt to determine the echocardiographic findings in a current, consecutive series of Afro-Caribbean patients referred for evaluation of atrial fibrillation and flutter. Between May 1998 and June 2000, 50 patients (mean age 67 years, 58% male) had echocardiograms done. Measurements included left atrial dimension (LA), left ventricular end-systolic dimension (LVESD), LV end-diastolic dimension (LVEDD), LV posterior wall thickness (LVPWT) and ventricular septal thickness (VST). Left ventricular ejection fraction (EF) was calculated. LA > 4 cm, LVPWT or VST > 13 mm, and LVEF < 50% were considered abnormal. Atrial fibrillation was seen in 92%, atrial flutter in 8%; 60% were chronic, 40% paroxysmal; 56% had congestive heart failure. The most frequent echocardiographic finding was LV hypertrophy (19/50, 38%). Left ventricular systolic dysfunction was present in 12/50, 24% (25% with LV hypertrophy also). Valvular disease (abnormal appearing valve, no Doppler study), was seen in 9/50, 18%. Normal findings ("lone atrial fibrillation") were seen in 10/50, 20%. Increased LA dimension was seen in 39/50, 78%. Patients with lone atrial fibrillation were younger (mean 56 years) than those with valvular disease (mean 64 years), LV systolic dysfunction (mean 69 years) and those with LV hypertrophy (mean 72 years). Thus, LV hypertrophy, probably secondary to hypertension, is the most frequent echocardiographic finding, with LV dysfunction (such as seen in coronary artery disease) seen less often. Valvular disease and lone atrial fibrillation rates are similar to rates in developed countries.     

肾嗜酸细胞腺瘤6 例诊治体会并文献复习

为提高肾嗜酸细胞腺瘤的诊断治疗水平,减少不必要的根治性肾切除术。本研究回顾分析2005 年3 月至2010 年11 月在中南大学湘雅二医院诊治的6 例肾嗜酸细胞腺瘤的症状,实验室检查、影像学检查、病理学检查结果,以及手术方式,并对患者进行随访。6 例患者无特殊症状,实验室检查未见明显异常,其中2例肾嗜酸细胞腺瘤在影像学上有相对特异性表现,手术前考虑肾嗜酸细胞腺瘤可能,行手术中快速冰冻切片检查,诊断为肾嗜酸细胞腺瘤,行肾脏部分切除术,余4 例行根治性肾切除术,术后随访1~5 年,6 例患者均未见复发或转移。目前认为肾嗜酸细胞腺瘤是一种良性肾脏肿瘤,依据典型的影像学表现和术中快速冰冻切片检查,可诊断部分典型的肾嗜酸细胞腺瘤,治疗上行肾脏部分切除术或者是肿瘤剜除术,尽量减少根治性肾切除术。明确诊断需依据术后病理学检查结果,术后宜密切随访。     

Clinical and functional outcomes of Paediatric femoral shaft fractures managed non-operatively at Nkhotakota District Hospital,Malawi

BackgroundFemoral shaft fracture is a common paediatric injury, managed non-operatively with skin traction in Malawian public hospitals. The clinical and functional outcomes of this treatment modality are unknown in Malawi.MethodsWe retrospectively identified all children who were managed at Nkhotakota District Hospital with skin traction after sustaining closed femoral shaft fractures from January 1, 2013 to December 31, 2016. We collected demographic characteristics and treatment history from the patient''s inpatient medical records, then invited each patient to undergo in-person follow-up clinical and functional assessment.ResultsWe identified 149 patients. Gallows traction 26 (17%) and 123 Bucks skin traction (83%). The mean age for Gallows traction was 10 months (95% CI: 8–11), most were males (16, 62%). Fall was the most common cause of injury (19, 73%), and mean hospitalization of 15.8 days (95% CI: 13.8–17.9). Eighteen patients (69%) were followed up at a mean of 4.2 years after discharge, all were full weight bearing, had achieved radiographic fracture union, and had no functional limitations or pain during regular activity. Buck''s skin traction mean age was 5.2 years (95% CI: 4.7–5.8), most were males (82, 67%), and fall (85, 69%). We followed up 83 patients (67%) at a mean of 4.1 years after hospital discharge, all of whom had achieved radiographic fracture union. All but one patient were full weight bearing and had normal gait. At follow-up, 14 patients (17%) reported some level of pain, 5 patients reported that their injury limited their return to household chores, and 2 reported that their injury also limited their return to school.ConclusionDespite the limitations of this study, non-operative management of paediatric femoral shaft fractures at Nkhotakota District Hospital may have good clinical and functional outcomes and minimal complications. A future prospective study may be helpful to confirm these findings.     

长期右室心尖部起搏对心室重构及心功能的影响

目的观察心脏结构及心脏功能正常的高度和Ⅲ度房室阻滞患者,长期右室心尖部起搏对其临床、心室重构和心功能的影响。为起搏电极植入部位提供参考。方法研究对象为入院更换起搏器的住院患者和门诊复诊的起搏器患者。病因为高度和Ⅲ房室传导阻滞;安装时无严重基础心脏病和心脏扩大,心功能正常,如LVEF〈50%且LVEDD〉55mm则除外研究;安装起搏器到随访时间大于5年,起搏比率〉80%。心室重构定义为：植入起搏器5年后,LVEDD增加10%,LVEF减少25%。心功能则NYHA分级以临床状况判断。结果研究共入选82例患者,男性39例（47.6%）,女性43例（52.4%）;随访时年龄12～91岁,平均（66.97±13.19）岁。两次评估相隔的平均时间是8.7年（104.4个月）。植入前,平均LA=37.0mm,平均LVEDD=50.23mm,平均LVEF=64.87%;植入后平均LA=39.39mm（P=0.000163）,平均LVEDD=50.82mm（P=0.177842）,平均LVEF=60.50%（P=0.000104）。有4个病人（占4.87%）出现了心室重构且伴有心功能分级恶化,其中3例为植入起搏器后发生前壁心肌梗死患者,1例为2型糖尿病患者。未发生心室重构的患者均没有临床心力衰竭症状。结论通过长期随访发现,心脏结构及心功能正常患者长期右室心尖部起搏,一般不会发生心室重构及临床心功能恶化。对于这些患者,右室心尖部是安全有效的起搏电极导线植入部位。     

Acute myopericarditis masquerading as acute myocardial infarction

Patients with abrupt onset of chest pain,ischemic ECG abnormalities and elevated levels of cardiac markers could be given a diagnosis of acute myocardial infarction.However,some other diseases should be taken into consideration in this clinical setting when coronary arteries are proven to be normal.Here we report a case of acute myopericarditis with clinical presentation of myocardial infarction and normal coronary anatomy.The Herpes Simplex Virus II was considered as the organism causing myopericarditis and the patient was recovered by the treatment with valacicloavir.A precise diagnosis is a prerequisite of successful treatment and favorable prognosis.