包虫病治疗的现状概况

包虫病 (Hydatid disease)主要是由细粒棘球蚴和泡球蚴寄生于人体内和动物体内而引起的一种人兽共患病 ;它严重危害人体健康和生命 ,影响畜牧业的发展。目前对于包虫病的治疗 ,仍然主要以外科手术为主 ,药物治疗为辅。随着医疗卫生事业的发展 ,包虫病的治疗方法也在不断改进和发展。下面就包虫病治疗现况做一简要综述。1　外科手术治疗1 .1　手术治疗 :近几十年来 ,国内外在包虫病的外科手术治疗方面取得了巨大的进步。手术方法不断改进和创新 ,减少了并发症 ,缩短了住院时间 ,减轻了病人的经济负担。通过外科手术可以直接从包虫病患者体内…     

泡型肝包虫病的外科治疗现状

泡型肝包虫病(HAE)是由多房棘球蚴绦虫引起的一种人畜共患性疾病。目前其治疗方式主要以根治性手术切除为主,药物治疗为辅。介绍了根治性手术切除、消融技术及姑息性手术等在HAE治疗中的应用现状;总结了自体肝移植的主要适应证,为选择治疗HAE的策略提供了一定的经验和参考依据。     

包虫病的研究进展

包虫病的研究进展重庆医科大学传染病寄生虫病研究所陈雅棠包虫病（ｈｙｄａｔｉｄｄｉｓｅａｓｅ）又称棘球蚴病（ｅｃｈｉｎｏｅｏｃｃｏｓｉｓ），是一种严重危害人畜健康的人兽共患寄生虫病。本病由棘球属绦虫的中绦期幼虫引起。其中２种因分布广泛并在人体内可引起严...     

我国包虫病流行现况

至１９９２年，据不完全统计近４０年我国１４０家医院的囊型包虫病手术患者，总计在２７７１６例，地理分布较广泛，主要见于西部和北部的新疆，甘肃，青海，宁夏，陕西，四川，西藏和内蒙古等８省区，另有１２省为散在分布或仅见个案报告，根据６省流行区２６个组人群囊型包虫病的普查，ＩＨＡ和ＥＬＩＳＡ阳性率分别为０．４６％～１１．７％，和１．２％～３２．４％，感染程度随地区的不同而异，Ｂ型超声检出囊虫百分率为０．６     

腹膜后包虫病1例

腹膜后包虫病１例万荣华郭德和宁夏医学院附属医院胸心外科银川市７５０００４主题词腹部棘球蚴病分类号Ｒ５３２３２１病例报告女，１８岁，学生。因右下腹包块４月及左肺包块２周入院。既往有犬羊接触史。查体：Ｔ３７℃，Ｐ８０次／ｍｉｎ，Ｒ２０次／ｍｉｎ，Ｂ...     

冠状动脉心肌桥合并其他心脏病外科治疗和随访观察

目的:冠状动脉心肌桥在心脏收缩时受压迫可能引起心肌缺血。本文目的在于探讨心肌桥合并其他心脏病进行外科手术的治疗效果及术后中、远期随访观察。方法:1999年1月至2006年12月24例心肌桥合并其他心脏病患者在我院行心肌切开术和(或)冠状动脉旁路移植术(CABG),合并其他心脏病同期手术。所有患者均在全麻体外循环下完成手术,其中行心肌切开术11例,同时行二尖瓣成形2例、二尖瓣置换2例、主动脉瓣置换1例、双瓣置换并三尖瓣成形2例、CABG术3例及房间隔修补1例;心肌桥行CABG术13例,同时行二尖瓣置换3例、二尖瓣成形2例、主动脉瓣置换2例、双瓣置换并三尖瓣成形2例、左心室流出道疏通3例、升主动脉替换1例。结果:手术成功率100%,没有医院内死亡,所有患者均康复出院。1例二尖瓣置换和心肌切开术后2小时,急性前壁心肌梗死行CABG术,顺利恢复。在行CABG术的13例病例中,除1例外,其他均采用左侧乳内动脉与前降支吻合。2例失访,随访率92%,平均随访时间38个月(6~87个月)。16例患者无任何不适,另外6例偶有心悸、胸闷、气短等,症状较手术前明显好转。所有随访患者均无胸痛发作。患者心功能明显改善,心功能Ⅰ级15例、Ⅱ级7例。所有22例患者在随访中未发生心肌梗死、死亡或需再次血运重建。结论:心肌桥合并其他需要手术治疗心脏病者,肌桥在收缩期狭窄大于50%,可能导致心肌缺血时,应同期手术治疗。外科手术能有效改善心肌桥引起的心肌缺血,手术风险小,中、远期疗效满意。     

心肌缺血高压氧治疗对心脏起搏器的影响

为探讨高压氧对安装心脏起搏器的心肌缺血病人的治疗价值和安全性 ,前瞻性地分析了 38例安装心脏起搏器伴心肌缺血的病人高压氧治疗前后起搏阈值、心电图、血压及一氧化氮 (NO)、心钠素 (ANP)、血管紧张素Ⅱ(AT Ⅱ )的变化。结果 :高压氧治疗后 ,心肌缺血的心电图表现改善 ,总有效率为 92 .1% ;起搏阈值电压显著降低(1.6 2± 0 .6 8vs 1.91± 0 .6 1V ,P <0 .0 1)、脉宽显著变窄 (0 .2 5± 0 .12vs0 .2 9± 0 .10ms ,P <0 .0 1) ;NO由治疗前 5 7.89± 6 0 .82 μmol/L提高到治疗后 6 3.87± 48.0 7μmol/L(P <0 .0 1) ;ANP、AT Ⅱ起搏后显著降低 (分别为 179.95±5 2 .2 9vs 186 .37± 5 4.11pg/ml,P <0 .0 1;312 .37± 6 7.84vs 331.71± 75 .44pg/ml,P <0 .0 5 ) ,血压下降 (P <0 .0 1)。结论 :高压氧治疗可改善心肌缺氧 ,降低起搏阈值     

Myocardial and Pericardial Disease in HIV

Opinion statement Cardiovascular complications are frequently encountered in the HIV-infected population. Cardiac care providers should implement appropriate preventive, screening, and therapeutic strategies to maximize survival and quality of life in this increasingly treatable, chronic disease. All HIV-infected individuals should undergo periodic cardiac evaluation, including echocardiography, in order to identify subclinical cardiac dysfunction. Left ventricular (LV) dysfunction can result from, or be exacerbated by, a variety of treatable infectious, endocrine, nutritional, and immunologic disorders. Aggressive diagnosis and treatment of these conditions may lead to improvement or even normalization of myocardial function. Endomyocardial biopsy should be considered to direct etiology-specific therapy. Standard measures for the prevention and treatment of congestive heart failure are recommended for HIV-infected patients. Afterload reduction with angiotensin-converting enzyme inhibitors may be indicated for patients with elevated afterload and preclinical LV dysfunction diagnosed by echocardiogram. However, judicious drug selection and titration are necessary in this cohort of patients with frequent autonomic dysfunction, at risk for a number of potentially lethal drug interactions. Carnitine, selenium, and multivitamin supplementation should be considered, especially in those with wasting or diarrhea syndromes. Monthly intravenous immunoglobulin (IVIG) infusions have been demonstrated to preserve LV parameters in HIV-infected children; ventricular recovery has been documented in some children with recalcitrant HIV-related cardiomyopathy following IVIG infusion. We support the use of immunomodulatory therapy in the pediatric population, and look forward to further study into the efficacy and broader application of this approach. Highly active antiretroviral therapy (HAART) may be associated with dyslipidemia and the metabolic syndrome. This should be treated with dietary and possibly with pharmacologic interventions. Drug interactions need to be considered when instituting pharmacologic therapies. Pericardial effusions are often seen in patients with advanced HIV infection. Asymptomatic effusions are most often nonspecific in nature, related to the proinflammatory milieu found in advanced AIDS. Nonspecific effusions are a marker of advanced disease and do not require exhaustive etiologic evaluation. In contrast, large or symptomatic effusions are often associated with infection or malignancy, and warrant thorough investigation and etiology-specific treatment.     

The Relationship of Pleural and Pericardial Effusion With Pulmonary Hemodynamics in Patients With Pulmonary Hypertension

BackgroundThe relationship between the presence of pleural and pericardial effusion in reference to hemodynamic parameters remains unclear in ambulatory patients with pulmonary hypertension (PH).MethodsConsecutive patients who underwent right catheterization (RHC) for the evaluation of pulmonary hypertension were enrolled. Point-of- care ultrasound was performed prior to the RHC to determine the presence of pleural effusion and pericardial effusion. We conducted a cross-sectional study to determine the association between presence of pericardial and pleural effusion with pulmonary hemodynamic variables.ResultsTwenty-five (78.1%) of 32 patients had evidence of PH by RHC. Mean pulmonary artery pressure of the population was 40.6 mmHg, and 68% (17/25) had WHO group I PH. Six (24.0%) of 25 PH patients had pleural effusions identified, of which 4 out of 6 (66.7%) had a pulmonary artery wedge pressure >15 mmHg. Eleven (44.0%) of the 25 PH patients were also found to have pericardial effusions, and most of those patients 10/11(90.9%) had an elevated right atrial pressure >10 mmHg. The presence of a pleural effusion was associated with a pulmonary artery wedge pressure >15 mmHg (p = 0.032) and the presence of a pericardial effusion was associated with a right atrial pressure >10 mmHg (p = 0.004). Detection of pleural effusion had a poor positive predictive value (67%) for the presence of pulmonary venous hypertension, whereas presence of a pericardial effusion was highly predictive (89%) of the presence of systemic venous hypertension.ConclusionsSystemic venous hypertension was associated with the presence of pericardial effusions, while pulmonary venous hypertension is associated with pleural effusion development in ambulatory patients with pulmonary hypertension.     

Extracellular Myocardial Volume in Patients With Aortic Stenosis

BackgroundMyocardial fibrosis is a key mechanism of left ventricular decompensation in aortic stenosis and can be quantified using cardiovascular magnetic resonance (CMR) measures such as extracellular volume fraction (ECV%). Outcomes following aortic valve intervention may be linked to the presence and extent of myocardial fibrosis.ObjectivesThis study sought to determine associations between ECV% and markers of left ventricular decompensation and post-intervention clinical outcomes.MethodsPatients with severe aortic stenosis underwent CMR, including ECV% quantification using modified Look-Locker inversion recovery–based T1 mapping and late gadolinium enhancement before aortic valve intervention. A central core laboratory quantified CMR parameters.ResultsFour-hundred forty patients (age 70 ± 10 years, 59% male) from 10 international centers underwent CMR a median of 15 days (IQR: 4 to 58 days) before aortic valve intervention. ECV% did not vary by scanner manufacturer, magnetic field strength, or T1 mapping sequence (all p > 0.20). ECV% correlated with markers of left ventricular decompensation including left ventricular mass, left atrial volume, New York Heart Association functional class III/IV, late gadolinium enhancement, and lower left ventricular ejection fraction (p < 0.05 for all), the latter 2 associations being independent of all other clinical variables (p = 0.035 and p < 0.001). After a median of 3.8 years (IQR: 2.8 to 4.6 years) of follow-up, 52 patients had died, 14 from adjudicated cardiovascular causes. A progressive increase in all-cause mortality was seen across tertiles of ECV% (17.3, 31.6, and 52.7 deaths per 1,000 patient-years; log-rank test; p = 0.009). Not only was ECV% associated with cardiovascular mortality (p = 0.003), but it was also independently associated with all-cause mortality following adjustment for age, sex, ejection fraction, and late gadolinium enhancement (hazard ratio per percent increase in ECV%: 1.10; 95% confidence interval [1.02 to 1.19]; p = 0.013).ConclusionsIn patients with severe aortic stenosis scheduled for aortic valve intervention, an increased ECV% is a measure of left ventricular decompensation and a powerful independent predictor of mortality.     

非心脏手术患者围手术期心肌梗死的处理

围手术期心肌梗死是拟行非心脏手术的患者发病和死亡的主要原因。而围手术期心肌梗死的发生率正随着外科手术与麻醉的发展和拟行外科手术人数的增多而逐渐升高。尽管有很多近期的研究、综述和指南均把非心脏手术围手术期心脏危险的评估，心肌缺血和心肌梗死的预防作为关注焦点，但有关围手术期心肌梗死一旦发生时相应处理方法的研究和报道仍为数不多。因此就主要对外科手术背景备件下的围手术期心肌梗死的流行病学和其可能的发生机制等进行介绍，同时对其诊断与治疗重点进行探讨。     

Incidence and Significance of Pericardial Effusion in Patients With Pulmonary Arterial Hypertension

Background

The incidence of pericardial effusion (PEF) during long-term follow-up among patients with pulmonary arterial hypertension (PAH) is unknown. We aimed to determine the incidence and prognostic significance of developing a new PEF among PAH patients.

Methods

Records of consecutive patients diagnosed with PAH between January 1990 and May 2010 were reviewed. Patients had systematically undergone right heart catheterization, transthoracic echocardiography, and coronary angiography during their initial assessment as well as routine echocardiograms during follow-up. Effusions were graded as small (echo-free space in diastole <10 mm), moderate (10-20 mm), or large (≥ 20 mm).

Results

The entire cohort consisted of 154 patients. The prevalence of identified PEF during initial assessment was 28.6%. The incidence of PEF among patients with no effusions who had additional echocardiographic studies during follow-up (n = 102) was 44.1%. Patients who developed PEF during follow-up had no differences with respect to baseline characteristics, associated aetiologies, hemodynamic parameters, and extent of coronary disease. Among these 102 patients, survival estimates were 94.9%, 75.0%, and 62.4% at 1, 3, and 5 years, respectively. Development of a PEF that was at least moderate-sized at its first appearance was a predictor of mortality in univariate (hazard ratio, 6.85; 95% confidence interval, 2.60-18.10) as well as multivariate analysis (hazard ratio, 3.95; 95% confidence interval, 1.26-12.40).

Conclusions

PEF develops frequently in PAH patients. In patients with no PEF at baseline, the appearance of a new moderate-size or larger PEF is associated with increased mortality, whereas no significantly increased mortality was observed when a small PEF develops.