1例梅毒性升主动脉瘤合并主动脉瓣关闭不全病人的护理

梅毒性升主动脉瘤是因梅毒螺旋体侵入主动脉壁引起的炎症性病理改变 ,可扩展到主动脉瓣区形成主动脉瓣关闭不全[1] 。临床上极少见。我院 2 0 0 4年 3月收治 1例病人给予精心治疗和护理 ,术后 2周痊愈出院。现将护理体会报告如下。1　病例介绍　　病人 ,男 ,63岁 ,主因胸骨后疼     

梅毒性主动脉瘤的外科诊治策略

目的：分析梅毒性主动脉瘤患者的外科诊治经验，探讨梅毒性主动脉瘤的疾病特点及治疗方法。方法：选取2010年10月至2018年8月在海军军医大学长海医院诊断为梅毒性主动脉瘤的20例患者，包括12例非急诊手术患者和8例急诊手术患者。所有患者梅毒血清学检验结果均呈阳性，同时全主动脉CT增强造影提示主动脉明显扩张。对于非急诊患者，术前给予驱梅治疗及激素治疗以降低患者梅毒血清学指标水平，同时预防吉海反应的发生；对于急诊入院的患者，及时进行手术干预，预防主动脉瘤破裂导致死亡。结果：在接受治疗的20例患者中（无论是在急诊手术还是非急诊手术），呼吸机辅助时间、ICU停留时间、住院时间，术后24h和48h白细胞计数、中性粒细胞比例，术后感染等结果均优于常规动脉瘤手术患者。病理染色提示，血管壁炎性细胞浸润，且炎性细胞主要位于滋养血管周围。术后随访结果提示，两组患者术后均取得了良好的远期效果。结论：对于主动脉瘤患者，应充分考虑梅毒性主动脉瘤的可能。对于非急诊患者，常规药物治疗配合手术是治疗的首选手段；对于主动脉内径大于6cm，或发生急性主动脉夹层的急诊患者，直接手术更为安全、可行、有效。     

彩色多普勒超声诊断小儿腹主动脉瘤1例

患儿男,10岁.咳嗽半个月突然并发剧烈腹痛.家长述4年前曾因腹痛来本院就诊,CT检查诊断为腹主动脉瘤.     

A case of chronic dissecting aortic aneurysm complicated with rupture into the right atrium: Diagnosis by transesophageal echocardiography

Although rupture of a dissecting aortic aneurysm into the pericardial sac, pleural cavities, or mediastinum is a frequently encountered complication of this entity, rupture into a right-sided cardiac chamber is extremely rare. An 80-year-old woman was admitted to this institution because of dyspnea and facial edema. One year before admission, a diagnosis of dissecting aortic aneurysm (Stanford A type) was made based on results of magnetic resonance imaging and transesophageal echocardiography (TEE); however, the patient and her family refused surgical therapy. On admission, blood pressure was 120/60 mmHg, and a Levine 3/6° continuous murmur was audible at the third and fourth intercostal spaces of the right sternal border. Chest x-ray film showed moderate cardiomegaly, congested lung fields, and bilateral pleural effusion. A two-dimensional echocardiogram revealed severe aortic root dilatation 80 mm in diameter with the intimal flap. Color flow Doppler imaging demonstrated abnormal flow toward the back space in dilated ascending aorta. Continuous wave Doppler imaging showed the peak velocity of this flow to be 4.8 m/s. This high-velocity flow strongly suggested that the dissecting aortic aneurysm had ruptured into the right-sided cardiac chamber, and shunt flow from the false lumen of the aortic aneurysm into the right atrium was directly visualized by TEE. Our diagnosis, based on these findings, was chronic dissecting aortic aneurysm with communication into the right atrium. In view of the patient’s deteriorating clinical condition, cardiac catheterization was not performed before surgery. Surgery revealed an aneurysm of the ascending aorta measuring 90 mm in diameter and multiple fistulas approximately 2 to 3 mm in diameter arising from the false lumen of the aorta into the right atrium at the base of the atrial appendage. The patient underwent successful replacement of the ascending aorta and closure of the aorto-right atrial fistulas. She had an uneventful postoperative course and was discharged 7 weeks after surgery.     

超声诊断腹主动脉瘤破裂并腹膜后血肿1例

正患者男,78岁,无明显诱因出现右腰部疼痛3 h。体格检查:脉搏63次/min,血压117/78 mm Hg(1 mm Hg=0.133 kPa),神志清醒,腹部稍膨隆,右侧腰部有叩压痛。急诊腹部超声检查:肝、胆、胰、脾、双肾均未见明显异常;腹主动脉中下段呈梭形扩张,最宽处管径约5.6 cm,扩张段长度约12.0 cm(图1),扩张处管腔内见涡流样絮状回声,该处管壁内膜层见大小不一的斑片状强回声,可探及长条状稍低回声实体物附壁。脐下1 cm处扩张的腹主动脉右侧壁内见不规则裂隙样回声中断。双侧髂总动脉管腔局限性扩张,左侧最宽处管径约4.1 cm,右侧最宽处管径约3.0 cm,腔内透声可,内见少许斑点状强回声附壁。     

Acute abdominal aortic aneurysm rupture presenting as transient paralysis of the lower legs: a case report

This article describes the case of a 40-year-old man with transient paralysis of both legs as the major symptom of an acute abdominal aortic aneurysm rupture presumably due to the occlusion of blood flow to the conus medullaris.     

Paralysis: a rare presentation of abdominal aortic aneurysm thrombosis

We report an acute thrombosis of an abdominal aortic aneurysm presenting with paralysis of a lower extremity. The usual presentation of such thrombosis is vascular compromise of the lower extremities. When the thrombus obstructs the artery of Adamkiewicz, the main blood supply to the lower spinal cord, spinal ischemia and paralysis can occur. Mechanisms of aortic occlusion and treatment of aortic thrombosis are briefly outlined.     

主动脉右冠状动脉窦瘤破裂入右心房超声表现1例

患者男,46岁,因“4个月前无明显诱因出现活动后心悸、气短、伴头晕,曾晕厥2次,约10s后意识恢复,胸闷,偶感心前区疼痛”就诊.查体:心尖搏动位于胸骨左缘第6肋间锁骨中线外侧1.0 cm,心浊音界向左下扩大,胸骨左缘5、6肋间可闻及4级收缩期吹风样杂音.颈静脉充盈,肝脾肋下未触及,双下肢无水肿.心电图示窦性心律,完全性右束支传导阻滞,右心室增大.     

A rare case of spontaneous rupture of the urinary bladder.

An extremely rare case of spontaneous intraperitoneal rupture of the urinary bladder, caused by a combination of a tumor of the vesical wall and an impacted urethral stone, is reported. The patient's symptoms suggested a perforated hollow viscus. Under general anesthesia the urethral stone was removed, while at laparotomy a diffuse peritonitis with blood-stained purulent fluid emerging from the ruptured bladder was found. The vesical wall was repaired and the peritoneal cavity was drained. In spite of the patient's advanced age and debilitated condition and the generalized peritonitis, the postoperative course was uneventful and the patient recovered promptly. Although spontaneous rupture of this kind is rare, one needs to consider unsuspected bladder rupture in any acute abdomen, especially if the patient is in the prostatic age group or has voiding problems.     

The draped aorta sign of impending aortic aneurysm rupture

Abdominal Radiology -     

Acute rupture of an aortic false aneurysm treated with a stent-graft.

PURPOSE: To report the use of an aortic endograft to treat a ruptured false aneurysm at the anastomosis of an aortofemoral bypass graft. METHODS AND RESULTS: A 68-year-old man with a 30-year-old aorto-right femoral bypass and multiple comorbidities was admitted to the hospital complaining of acute abdominal pain. Imaging identified a 60-mm ruptured aortic false aneurysm with associated retroperitoneal hematoma, a 9-cm right femoral false aneurysm, and a calcified 23-mm left common iliac aneurysm. Two slightly overlapping Vanguard straight stent-grafts were implanted in the aorta and left common iliac artery in an emergency procedure owing to the patient's high surgical risk. The anastomotic false aneurysm and the bypass were excluded. A left-to-right femorofemoral bypass was performed to re-establish flow to the right femoral artery with ligation of the external iliac artery. The patient recovered uneventfully. He remained well with a successful repair until his death of a myocardial infarction 6 months after the procedure. CONCLUSIONS: Endovascular grafting can be used successfully for the urgent treatment of aortic false aneurysm rupture.