Unilateral breast edema in congestive heart failure--a mimic of diffuse carcinoma.

Mammography in a patient with congestive heart failure showed unilateral skin thickening and a reticular pattern mimicking diffuse carcinoma. Resolution after treatment of the heart failure established the abnormality as secondary to dependent edema.     

Cardiopulmonary effects of intravenous fluid overload: radiologic manifestations.

Large volumes of normal saline were infused intravenously in 6 dogs until obvious pulmonary edema was observed radiographically. Following volume overload, statistically significant increases occurred in the size of the heart, left atrium, pulmonary arteries and veins, and systemic veins, without the development of congestive heart failure (CHF). The left ventricular end-diastolic pressure remained normal, and cardiac output and stroke volume increased. The results suggest that, in the absence of left ventricular failure, acute volume overload may simulate the radiographic changes produced by CHF. Pulmonary edema may have occurred at least partly from a marked decrease in serum colloid osmotic pressure.     

平胃散对心梗后心衰大鼠湿阻中焦证醛固酮的影响

目的 观察平胃散心衰湿阻中焦证大鼠模型的ALD的变化,从而了解平胃散对心衰的作用.方法 塑造心衰模型、心衰湿阻中焦证模型,将大鼠分为正常对照组、心衰模型组、心衰湿阻中焦证模型组、平胃散组,采用放免法检测ALD的浓度.结果 与正常对照组比较,心衰模型组和心衰湿阻中焦证模型组ALD明显升高,具有显著性差异(P《0.01);经治疗后,平胃散组与心衰模型组及心衰湿阻中焦证模型组比较,ALD均明显降低,具有显著性差异(P《0.01).结论 平胃散能明显降低ALD的分泌,使心衰湿阻中焦证大鼠潴留的水、钠得以排泄,从而改善心衰的症状.     

低钠血症对老年人心力衰竭预后的影响

目的　探讨低钠血症对老年人心力衰竭的影响。方法　选择 60岁以上慢性充血性心力衰竭 116例 ,其中并发低钠血症者 (低钠组 )5 4例 ,正常血钠者 (对照组 ) 62例 ,比较两组病死率 ,同时比较心衰级别与血钠浓度的关系。结果　老年心力衰竭低钠组比正常血钠组有更高的病死率 (P <0 .0 1) ,低血钠组中重度心衰组与轻、中度心衰组比较 ,血钠浓度更低 (P <0 .0 1)。结论　老年人心力衰竭级别越高 ,血钠浓度越低 ,其病死率越高 ;低钠血症与病死率有明显相关性     

氨基末端脑钠肽水平与老年血液透析合并心力衰竭死亡的相关性

 

目的 研究氨基末端脑钠肽(N terminal-pro brain nalriuretic peptide,NT-proBNP)水平与老年维持性血液透析并充血性心力衰竭死亡的相关性。方法 选择维持性血液透析并充血性心力衰竭入院患者52例,因心力衰竭死亡22例为死亡组,心力衰竭缓解30例为非死亡组,比较住院前、住院期间死亡组和非死亡组NT-proBNP水平,采用二分类Logistic回归分析影响死亡的相关因素,偏相关分析影响死亡组NT-proBNP水平的相关因素,受试者工作特征(ROC)曲线评价NT-proBNP水平对死亡的预测效能。结果 死亡组入院时NT-proBNP中位数为31 000 ng／L,与非死亡组入院时NT-proBNP中位数28 500 ng／L比较无统计学意义;死亡组住院期间NT-proBNP中位数为9200 ng／L,明显高于非死亡组NT-proBNP中位数4700 ng／L,差异有统计学意义(P＜0.01);二分类Logistic回归分析提示住院期间NT-proBNP水平为影响死亡的唯一相关因素(P＜0.01);左室EF值、透析间期体质量增加值、左室扩大为影响死亡组住院期间NT-proBNP水平相关因素(P＜0.01)。死亡组住院期间NT-proBNP的AUC值为0.962,差异有统计学意义(P＜0.05);NT-proBNP＞7650 ng／L作为界值(Cut off值)的敏感度为82.4%,特异度为84%;非死亡组住院期间NT-proBNP的AUC值为0.038,差异无统计学意义。结论 老年维持性血液透析并充血性心力衰竭住院期间高水平NT-proBNP与死亡具有相关性,可作为预测死亡的指标。

     

X-ray changes in the thoracic organs in acute heart infarct

Chest X-rays were used to evaluate the hemodynamic status of 86 patients with acute myocardial infarction. The chest films, divided into three groups depending on the degree of pulmonary venous hypertension revealed: grade 1, pulmonary-venous congestion; grade 2, interstitial pulmonary edema; grade 3, diffuse alveolar edema. On clinical examination, four grades of congestive heart failure were distinguished in acute myocardial infarction. In 69% of our patients radiological and clinical grading of left ventricular failure led to precisely the same conclusions. Pulmonary capillary wedge pressure was measured in 31 patients with acute infarction. Radiological criteria of the degree of pulmonary vascular congestion, when related to pulmonary capillary wedge measurements, provide a basis for consistent therapy of left ventricular failure secondary to acute myocardial infarction.     

托拉塞米治疗慢性心力衰竭临床观察

目的观察托拉塞米治疗慢性心力衰竭的疗效及安全性。方法 118例患者随机分为托拉塞米治疗组及呋塞米组,两组基础用药一致,比较两组治疗后的体重下降、水肿变化、心功能变化及不良反应。结果两组均可使慢性心力衰竭患者体重下降,水肿减轻,心功能改善,两组对比差异无统计学意义;不良反应发生率两组比较差异无统计学意义,但托拉塞米组低钾发生率低于呋塞米组。结论托拉塞米对慢性心力衰竭疗效肯定,可改善心功能,减轻水肿,特别适用于同时存在低钾的慢性心力衰竭的患者。     

Gallium-67 and pulmonary complications of amiodarone

A 66-year-old white man with amiodarone pneumonitis is presented. The diagnosis was made with the aid of Ga-67 imaging, which is a sensitive method of detecting amiodarone pulmonary toxicity in patients with symptomatic pulmonary infiltrates on chest radiographs. Ga-67 imaging is especially useful in distinguishing amiodarone pneumonitis from congestive heart failure.     

卡托普利与倍他乐克联用治疗充血性心力衰竭的临床疗效观察

目的探讨卡托普利与倍他乐克联用治疗充血性心力衰竭的临床疗效。方法将90例充血性心力衰竭患者分为治疗组和观察组,治疗组在常规治疗基础上给予卡托普利、倍他乐克,对照组仅给卡托普利治疗,观察两组的治疗效果。结果治疗组总有效率82.20%,对照组为65.00%,治疗组疗效明显优于对照组。结论卡托普利与倍他乐克联用治疗充血性心力衰竭疗效满意,可以改善心脏功能,减少住院时间,且价格便宜,值得临床推广应用。     

利喜定治疗充血性心力衰竭临床观察

目的　观察利喜定治疗充血性心力衰竭的临床疗效。方法　 30例充血性心力衰竭患者 ,先以利喜定 12 .5mg稀释于 2 0ml生理盐水中于 3～ 5min内静脉注射 ,继以利喜定 5 0mg、多巴胺 2 0mg加于 2 5 0ml液体中静滴 ,每日 1次 ,滴速为利喜定 10 0～ 4 0 0 μg/min ,连用 5～ 7d。 结果　利喜定可显著降低收缩压、舒张压 ,升高血氧饱和度、左室射血分数 ,不引起反射性心率增快。结论　利喜定治疗各种原因引起的充血性心力衰竭 ,可有效改善患者的临床症状和血流动力学指标     

Mammographic and ultrasonographic findings in bilateral breast cancer: a comparative study

To compare the results of mammographic and US examinations in unilateral and bilateral breast cancers in routine clinical work, the files of all patients with 825 preoperative mammograms and 525 preoperative US examinations operated on for primary breast cancer in the Oulu University Hospital from 1983 through 1993 were retrospectively reviewed. The only statistically significant difference noted in the mammographic findings was the false-negative rates in unilateral, bilateral and metachronous second breast cancers (6.8, 16.3 and 23.3 %, respectively). The differences were mainly due to the lower sensitivity of mammography in the detection of palpable bilateral breast cancers. The false-negative rate of US was also significantly higher in bilateral breast cancers (23 %) than in unilateral cancers (11 %), and significantly higher for nonpalpable than palpable cancers in both the bilateral and the unilateral groups. The mammographic failure rates and the difference between these two groups were most pronounced during the early study period, which underscores the importance of experience and dedicated imaging technique. The smaller tumour size at the time of diagnosis and probably the loss of the opposite breast for comparison have contributed to the higher false-negative rates in bilateral breast cancer. Received 25 April 1997; Revision received 1 September 1997; Accepted 6 October 1997     

Renal uptake of 99mTc-sulfur colloid in congestive heart failure

Renal uptake of 99mTc-sulfur colloid during liver and spleen imaging was observed in 4 patients; all had moderate to severe congestive heart failure. Four similar patients with this association have been reported. Although the exact mechanism of colloid uptake by the kidneys is not known, an association with congestive heart failure seems likely.     

Isolated absence of the right pulmonary artery with coexisting left-sided heart failure: case report and literature review

Isolated unilateral absence of the pulmonary artery (UAPA) exhibits a benign course and often goes undiagnosed until adulthood. We present a 39-year-old male admitted for left-sided congestive heart failure (CHF) exacerbation. However, chest radiograph demonstrated findings suspicious for UAPA that was ultimately confirmed on computed tomography. Because both CHF and UAPA present similarly with exercise intolerance and dyspnea, a high index of suspicion is required to secure the diagnosis, and in this case, symptoms attributed to CHF may have contributed to delay. A strong awareness of typical radiographic findings allows for initiation of confirmatory tests necessary for a correct diagnosis.     

Radiology residents' on-call interpretation of chest radiographs for congestive heart failure

RATIONALE AND OBJECTIVES: This study was designed to evaluate the performance of radiology residents in interpreting emergency department (ED) chest radiographs for congestive heart failure and to characterize the factors associated with a subsequent amended interpretation by an attending radiologist. MATERIALS AND METHODS: We retrospectively reviewed all amended reports for ED chest radiographs between January 2004 and July 2005 and identified those with discrepant interpretations regarding the diagnosis of congestive heart failure. A total of 1.9% (476 of 24,600) of chest radiographs were amended over the study period. Forty-eight patients (75% female, mean age 66 years) whose chest radiograph was amended for the diagnosis of congestive heart failure and were available for review formed the study population. A control group of 35 patients (69% female, mean age 67 years) were individually matched to a convenience subset of patients by age, gender, clinical indication, and radiographic projection. Chest radiographs were in the anteroposterior projection in 62% (30 of 48) of study patients and 60% (21 of 35) of controls. A blinded expert panel of three board-certified cardiothoracic radiologists jointly reviewed each chest radiograph for the presence or absence of congestive heart failure and its specific radiographic findings. RESULTS: The expert panel diagnosed congestive heart failure in 19% (9 of 48) of study patients and in 23% (8 of 35) of controls (P = .65). When present, congestive heart failure was mild to moderate in severity in both the study and control groups (P = 1.00). There was a significant difference in the expert panel agreement between the attending versus the resident interpretation (65% versus 35%, P = .008), for the study group. This resulted in fair agreement (kappa = 0.29) between the expert panel and the attending interpretation and no agreement (kappa = -0.29) between the expert panel and the resident interpretation. In contrast, the expert panel agreed with the joint resident/attending interpretation in 83% (29 of 35) of controls, yielding substantial agreement (kappa = 0.72). CONCLUSION: Interpretation of chest radiographs for congestive heart failure by radiology residents has a low error rate. The majority of chest radiographs with discrepant resident and attending interpretations were portable films of female patients with subtle radiographic findings of congestive heart failure, and were inherently difficult to interpret.     

倍他乐克治疗慢性充血性心力衰竭36例临床观察

目的观察倍他乐克治疗慢性充血性心力衰竭的疗效与安全性。方法入选71例心脏病伴轻、中度慢性充血性心力衰竭的患者，将其随机分为治疗组（n=36）和对照组（n=35）。对照组接受常规抗心力衰竭治疗；治疗组在常规治疗基础上加服倍他乐克，共治疗12用。治疗前后观察两组患者的心率、多普勒超声心动图检查左室射血分数（LVEF）、左室舒张末压内径（LVDd）及心功能情况。结果治疗组显效28例，占77.8％；有效6例，占16．7％；无效2例，占6．5％；总有效率为94．4％。对照组显效16例，占45．7％；有效10例，占28．6％；无效9例，占25．7％；总有效率为74．3％。治疗后两组之间的总有效率、心率和心功能差异均有统计学意义（P〈0．05）。结论在接受心力衰竭常规治疗基础上加服倍他乐克对改善心力衰竭症状具有艮好效果。     

基质金属蛋白酶参与左心室重构的机制探讨

目的 探讨基质金属蛋白酶家族（MMPs）MMP-2、3、9与心衰患者心肌重构的关系。方法 选择因二尖瓣关闭不全，心脏病接受二尖瓣置换术的CHF病人39例，正常对照38例（其中8例来自意外伤亡的器官捐献者）。彩色多普勒超声心动图检测心功能参数，免疫沉淀法检测心肌组织MMP-2、3、9。结果 瓣膜病所致心力衰竭病人心肌组织呈心肌重构的病理改变；心衰病人心肌组织蛋白表达较正常人高，且随心功能的恶化，MMP-2、3、9含量相对越高（P〈0．05或0．01）。结论 MMP-2、3、9表达量的增高与心肌重构的病理过程。是影响心衰患者心功能的重要因素之一。     

Unilateral megalencephaly: correlation of MR imaging and pathologic characteristics.

Unilateral megalencephaly is a rare and poorly understood malformation resulting in the enlargement of all or part of a cerebral hemisphere. The clinical and radiologic features of 12 patients with unilateral megalencephaly are presented; pathologic correlation was available in four. All patients had seizures and developmental delay. Two were in congestive heart failure as a result of arteriovenous shunting through the abnormal hemisphere. The affected hemispheres showed a wide spectrum of involvement. Anomalies of neuronal migration were present, and there was a roughly inverse correlation between the severity of hemispheric involvement and the magnitude of enlargement. This correlation is explained via a proposed mechanism of a mild hemispheric insult in the middle-to-late second trimester. One patient had an extremely anomalous hemisphere that did not have characteristics of a neuronal migration anomaly and may have been a hamartomatous malformation. Our correlation of the clinical, radiologic, and pathologic features of unilateral megalencephaly, together with a theory of pathogenesis, should help elucidate this rare malformation.     

The chest radiograph in legionnaires'' disease

The chest radiographs of 24 patients with documented Legionnaires' disease were evaluated. Twenty-two of the 24 patients had positive findings for the disease initially. There was unilateral involvement in 68% and the most common lung shadows were poorly marginated round opacities (46%), diffuse patchy (25%) and peripheral opacities (21%). At peak, 70% of patients had a lobar shadow. Pleural effusions were present in 39% of cases but could be explained by underlying congestive heart failure or renal failure in 7 of the 9. Although the findings are not specific, the radiologist should consider this diagnosis in a patient with compatible clinical history, a pneumonia of obscure etiology, and these radiographic manifestations.     

Effectiveness of chest radiography,lung ultrasound and thoracic computed tomography in the diagnosis of congestive heart failure

Hydrostatic pulmonary edema is as an abnormal increase in extravascular water secondary to elevated pressure in the pulmonary circulation, due to congestive heart failure or intravascular volume overload. Diagnosis of hydrostatic pulmonary edema is usually based on clinical signs associated to conventional radiography findings. Interpretation of radiologic signs of cardiogenic pulmonary edema are often questionable and subject. For a bedside prompt evaluation, lung ultrasound (LUS) may assess pulmonary congestion through the evaluation of vertical reverberation artifacts, known as B-lines. These artifacts are related to multiple minimal acoustic interfaces between small water-rich structures and alveolar air, as it happens in case of thickened interlobular septa due to increase of extravascular lung water. The number, diffusion and intensity of B lines correlates with both the radiologic and invasive estimate of extravascular lung water. The integration of conventional chest radiograph with LUS can be very helpful to obtain the correct diagnosis. Computed tomography (CT) is of limited use in the work up of cardiogenic pulmonary edema, due to its high cost, little use in the emergencies and radiation exposure. However, a deep knowledge of CT signs of pulmonary edema is crucial when other similar pulmonary conditions may occasionally be in the differential diagnosis.     

美托洛尔治疗充血性心力衰竭合并室性心律失常的观察

目的 观察美托洛尔治疗充血性心力衰竭合并室性心律失常患者的临床疗效。方法 40例NYHA心功能分级≥Ⅲ级充血性心衰合并室性心律失常患者,在常规抗心衰药物治疗基础上口服美托洛尔,治疗3个月前后24h动态心电图检查,超声心动图检查心功能,6min步行测试。结果 心功能改善,6min步行增加,室性心律失常的发生减少,而室性心律失常的减少与心功能改善密切相关。结论 美托洛尔用于心衰治疗不仅安全、可以改善心功能,提高患者生活质量,而且对减少室性心律失常的发生率也有较好效果。