Systemic lupus erythematosus presenting with cardiac tamponade due to a haemorrhagic pericardial effusion

A 14 year old girl presented with cardiac tamponade due to a haemorrhagic pericardial effusion. Systemic lupus erythematosus was diagnosed. Pericardial stripping was performed due to recurrence of the effusion despite pericardiocentesis and steroid therapy.     

剑突下心包开窗术治疗大量心包积液

目的 选择一种安全、有效、创伤小的方法,用于诊疗大量心包积液和心包填塞。方法 回顾性分析本院心胸外科４年期间收治的３０例大量心包积液或心包填塞塞患者诊闻过程。所有患者在心脏彩色超声确诊后,施行经剑突下心包开窗引流术,心包活检术。结果 引渡以后患者症状改善,８３％的２下平卧或下床活动。术中心包积液引流量为２００－２０００ｍｌ术后引流量０－２０００ｍｌ,引流时间２－３０ｄ,平均拔管时间为５．６ｄ,拔管     

Massive pericardial effusion in primary hypothyroidism

A 44 year old lady with primary hypothyroidism presented with massive pericardial effusion without cardiac tamponade. Pericardial tap was done twice and the effusion resolved as the hypothyroid state improved. She remained hypertensive despite the euthyroid state. She was discharged well with L-thyroxine and anti-hypertensive therapy.     

Pleuropericarditis and pericardial tamponade associated with inflammatory bowel disease

Extraintestinal manifestations have been described with inflammatory bowel disease (IBD). Cardiac involvement in IBD is rare and may present as pericardial effusion, myopericarditis and conduction defects. Here we present a case of IBD with asymptomatic pericardial tamponade. A 37-year-old African-American man with ulcerative colitis with history of previous colectomy with ileorectal anastomosis was hospitalized for resection of the stricture of ileorectal anastomosis. The patient was afebrile with stable vitals and modest jugular venous distension, but no pulsus paradoxus. Cardiopulmonary examination was normal. A CT scan done to evaluate rise in liver function tests following removal of stricture showed a large 3.1 cm pericardial effusion. A transthoracic 2-D echocardiogram showed a moderate-sized posterior pericardial effusion limiting left ventricular filling. Central venous pressure was 18 mm Hg and the patient underwent drainage of 300 ml of old bloody pericardial effusion. Pericardial biopsy showed organizing fibrinohemorrhagic chronically inflamed pericardium without granuloma or neoplastic process. Serologies for EBV, Coxsackie virus and hepatitides were negative. Drug-related pericarditis seems less likely as the patient was not on sulfasalazine, and ANA, dsDNA and rheumatoid factor titers were negative. The patient was diagnosed to have pericardial tamponade associated with IBD.     

Hyponatremia in patients with symptomatic pericardial effusion

BackgroundHyponatremia is related to cardiac tamponade in isolated case reports. However, the incidence of hyponatremia in patients with cardiac tamponade is still undetermined.MethodsIn a tertiary referral medical center, patients who presented with cardiac tamponade necessitating evacuation of pericardial effusion were included. Medical records were reviewed for the diagnosis of effusion and the underlying disease in each patient. Serum sodium concentrations before and after evacuation of effusion were analyzed.ResultsA total of 48 patients were identified during a 3-year period and 26 patients (54.2%) were found to have hyponatremia. The condition was mild (130–134 mEq/L) in eight; moderate (120–129 mEq/L) in 16; and severe (<120 mEq/L) in two patients. The frequency of hyponatremia was significantly higher in patients with malignancy-related rather than nonmalignancy-related cardiac tamponade (62.2% vs. 27.3%, p = 0.041). Nineteen patients had hyponatremia at presentation and had paired serum sodium concentrations measured after evacuation of pericardial effusion. The postevacuation serum sodium concentrations were significantly higher than the pre-evacuation levels in all patients (p < 0.001).ConclusionHyponatremia is common in patients with cardiac tamponade. However, prompt management of pericardial effusion will result in spontaneous and rapid recovery from hyponatremia.     

心包炎患者心包切除术后的病因分析

目的 :探讨心包炎心包切除术后的病因诊断 ,以提高心包炎的临床诊断水平。方法 :回顾性分析 5 2例行心包切除术并有病理检查结果的心包炎临床与病理资料。结果 :结核性 14例 ( 2 6 .9%) ,癌性 4例 ( 7.7%) ,非特异性改变 34例 ,其中 2例为创伤性、1例为放射性 ,其他 31例 ( 5 9.7%)原因不能确定。与非特异性组比较 ,结核性心包炎患者的病程较短 (P <0 .0 1) ,有发热、急性心包炎、中至大量心包积液和心脏压塞病史者较多 (P <0 .0 5～0 .0 1) ;4例癌性心包炎均表现为顽固性渗液性心包炎。结论 :缩窄性心包炎多数病例病因不明 ,在已知的病因中 ,以结核多见 ;顽固性心包渗液多见于恶性肿瘤。     

心包炎患者心包切除术后的病因分析

目的：探讨心包炎心包切除术后的病因诊断，以提高心包炎的临床诊断水平。方法：回顾性分析52例行心包切除术并有病理检查结果的心包炎临床与病理资料。结果：结核性14例(26.9％)，癌性4例(7.7％)．非特异性改变34例，其中2例为创伤性、1例为放射性，其他31例(59．7％)原因不能确定。与非特异性组比较，结核性心包炎患者的病程较短(P＜0．01)，有发热、急性心包炎、中至大量心包积液和心脏压塞病史者较多(P＜0．05—0．01）；4例癌性心包炎均表现为顽固性渗液性心包炎。结论：缩窄性心包炎多数病例病因不明，在巳知的病因中，以结核多见；顽固性心包渗液多见于恶性肿瘤。     

Hypothyroidism presenting as cardiac tamponade in Down syndrome

Down syndrome is the commonest chromosomal anomaly. It is often associated with hypothyroidism, which may rarely present with cardiac tamponade as the earliest manifestation and prompt treatment with L-thyroxine is life saving. A six-month-old female child diagnosed as a case of Down syndrome presented with shortness of breathing for last 1 1/2 months. Facial dysmorphism, characteristic of Down syndrome was present. Echocardiography revealed large pericardial effusion and right ventricular diagnostic collapse. A case of Down syndrome with hypothyroidism and cardiac tamponade was kept in mind. She was treated with L-thyroxine and clinical status improved.     

床边超声检查对心脏直视手术后并发症的监护价值

①目的探讨床边超声检查对心脏直视手术后并发症的监护价值。②方法把床边超声检查应用于５０例心脏直视手术监护。③结果应用床边超声检查可以及时发现急性心包压塞，准确掌握二次开胸止血时机，避免不必要的二次开胸手术；通过连续监测心包积液情况及时发现延迟性心包积液；帮助判断发生术后低心排出量综合征的原因；确定胸腔积液的量及最佳穿刺部位，引导穿刺抽液治疗。④结论床边超声检查对心脏直视手术后某些并发症的诊治具有较高的实用价值。     

不同止血方法应用于难治性产后出血的效果分析

目的探讨不同止血方法治疗难治性产后出血的有效性以及止血失败的原因。方法选择71例难治性产后出血产妇作为研究对象,其中行宫腔纱布填塞35例,宫腔阴道球囊压迫25例,子宫动脉栓塞介入治疗11例。将71例产妇按止血方法不同分为纱布填塞组（纱布组）、球囊压迫组（球囊组）和动脉栓塞介入组（介入组）,再按填塞治疗（包括纱布填塞和球囊压迫）的方式分为单纯填塞治疗组（填塞组）、填塞联合介入治疗组（填塞+介入组）以及填塞联合子宫切除（填塞+子宫切除组）3组。分别对各组的术中情况,术后发热、术后治疗等结果进行对照分析,并对止血失败的原因进行多因素分析。结果71例产妇产后出血量1 100~8 000 mL,止血成功64例,止血失败行子宫切除7例。止血方式不同的3组的术中出血量、产后24 h出血量以及输注红细胞悬液、血浆量差异均无统计学意义（P>0.05）。填塞方式不同的3组比较显示,术中出血量和产后24 h出血量均为填塞+子宫切除组最多（P < 0.01）,填塞+介入组次之（P < 0.01）,填塞组最少（P < 0.01和P < 0.05）;输注红细胞悬液和血浆量方面,填塞+子宫切除组均高于填塞+介入组和填塞组（P < 0.01）,填塞+介入组和填塞组间差异无统计学意义（P>0.05）。术后情况比较显示,纱布组的术后发热时间高于球囊组和介入组（P < 0.05）,球囊组和介入组之间差异无统计学意义（P>0.05）;住院时间、术后发热时间和抗生素使用时间按填塞组、填塞+介入组、填塞+子宫切除组次序逐渐增加（P < 0.05~P < 0.01）。对64例止血成功的产妇资料进行多因素分析,发现胎盘植入和弥散性血管内凝血是止血失败的危险因素（P < 0.01）。结论宫腔纱布填塞止血和球囊压迫止血效果无明显差异,但是球囊压迫止血可减低产褥感染发生率;合并胎盘植入,出现凝血功能异常时,填塞和介入的止血方式多难以奏效,需要尽快切除子宫。     

小儿心包积液28例临床分析

目的：探讨小儿心包积液的病因、分类及诊断。方法：病例回顾性分析。结果：28例中，化脓性心包积液4例，结缔组织疾病所致心包积液16例，肾病综合征所致心包答液4例，病毒性、肺吸虫性、幼年型粘液性水肿及肿瘤性心包积液各1例。治愈、好转25例，另3例，分别死于急性心包填塞，风湿性全心炎、心功能不全、呼衰、纵隔肿瘤广泛转移。结论：小儿心包积液，可由多种致病因素引起。其临床特点，对该病的诊治有重要意义。     

甲状腺功能减退性心包积液超声心动图分析

目的研究甲状腺功能减退性心包积液的超声改变,并探讨超声心动图对甲状腺功能减退性心包积液的诊断价值。方法以19例甲状腺功能减退性心包积液的超声心动图改变与正常人对比。结果 19例甲状腺功能减退性心包积液组左房内径、室间隔厚度、左室后壁厚度与正常对照组比较差异有统计学意义(P<0.01),均无心包填塞发生。结论彩色多谱勒超声心动图对甲状腺功能减退性心包积液的诊断与鉴别诊断有重要意义,其中左房扩大、左室舒张功能不全多发。     

Management of pericardial effusion by drainage: a survey of 10 years' experience in a city centre general hospital serving a multiracial population

The aim of the study was to determine the aetiology of large and symptomatic pericardial effusions and to review the management and subsequent outcome. A survey was done on a consecutive cases of patients who had undergone percutaneous pericardiocentesis over a 10 year period in a city centre general hospital serving a multiethnic catchment population. In all, 46 patients (24 male, 22 female; age range 16 to 90 years, mean 54 years) underwent a total of 51 pericardial drainage procedures (or attempted pericardiocentesis) between 1989 and 1998. Malignancy (44%), tuberculosis (26%), idiopathic (11%), and post-cardiac surgery (9%) were the most common causes of pericardial effusion. The most common presenting symptoms were breathlessness (90%), chest pain (74%), cough (70%), abdominal pain (61%) (presumed to be related to hepatic congestion), and unexplained fever (28%). In the 12 cases of tuberculous pericarditis, nine occurred in patients of Indo-Asian origin, and three in patients of Afro-Caribbean origin. Fever, night sweats, and weight loss were common among these patients, occurring in over 80% of cases of tuberculous pericarditis. Pulsus paradoxus was the most specific sign (100%) for the presence of echocardiographic features of tamponade, with strongest positive predictive value (100%). Although malignancy remains the most common cause in developed countries, tuberculous disease should be considered in patients from areas where tuberculosis is endemic. Percutaneous pericardiocentesis remains an effective measure for the immediate relief of symptoms in patients with cardiac tamponade, although its diagnostic yield in tuberculous pericarditis is relatively low.     

心房颤动经导管射频消融术并发急性心脏压塞的临床分析

目的 总结经导管射频消融治疗心房颤动并发心脏压塞的病例资料。方法 回顾性分析2014年6月~2016年3月在笔者医院接受导管射频消融治疗心房颤动的患者112例,分析其发生心脏压塞的发生率、临床特点、抢救效果。结果 112例患者中,6例患者发生心脏压塞,经导管射频消融术治疗心房颤动的患者心脏压塞发生率为5.35%。6例发生心脏压塞的患者中5例患者发生在术中,1例发生在术后2h。6例患者心脏压塞的首发表现主要为低血压、恶心、胸痛、意识模糊/意识丧失。本研究中6例患者经紧急处理后,其血流动力学能保持稳定,经心脏超声检查心包内未再有心包积液渗出。结论 心房颤动导管射频消融术并发心脏压塞需要早认识、早发现,心包穿刺引流是有效的治疗手段。     

Causes and prognosis of symptomatic pericardial effusions treated by pericardiocentesis in an Asian academic medical centre

INTRODUCTIONThis study aimed to investigate the causes, clinical management and outcomes of clinically significant pericardial effusions, and evaluate the practice of pericardiocentesis within an academic medical centre in Singapore, a multiethnic country in Southeast Asia.METHODSConsecutive patients undergoing pericardiocentesis at a single Asian academic medical centre were identified. Patient demographics, echocardiographic findings, investigations, pericardiocentesis procedural details and clinical progress were tracked using a comprehensive electronic medical records system.RESULTSOf 149 patients who underwent pericardiocentesis, malignancy (46.3%) was the most common cause of pericardial effusions, followed by iatrogenic postsurgical complications (17.4%). 77.3% of effusions were large and 69.8% demonstrated tamponade physiology. Pericardiocentesis guided by echocardiography and fluoroscopy was successful in 99.3% of patients and had a complication rate of 2.0%. Likelihood of effusion recurrence and survival to discharge was determined by the aetiology of the pericardial effusion. 24.6% of malignant effusions recurred, and the survival rate 12 months after drainage of a malignant pericardial effusion was 45.0%. Short-term mortality was highest among patients presenting with tamponade due to acute aortic syndromes and those with myocardial rupture due to ischaemic heart disease.CONCLUSIONCancer and iatrogenic complications were the most common causes of pericardial effusion in this large cohort of Singapore patients. Pericardiocentesis has a high success rate and relatively low complication rate. Prognosis and clinical course after pericardiocentesis are determined by the underlying cause of the pericardial effusion.     

Cardiac tamponade complicating leukaemia: immediate chemotherapy or pericardiocentesis?

Although leukaemic infiltration of the pericardium is frequently observed at post-mortem, clinically evident cardiac tamponade is rare. Two cases of cardiac tamponade complicating leukaemia are presented. One patient had cardiac tamponade as the initial presentation of acute lymphoblastic leukaemia and experienced complete resolution of the pericardial effusion within 6 days after chemotherapy without therapeutic pericardiocentesis. The other patient with chronic myeloid leukaemia developed cardiac tamponade requiring pericardiocentesis as the first sign of acute blastic transformation. The roles of early chemotherapy and pericardiocentesis in managing this complication are discussed.     

超声引导下心包置管引流在心脏介入术并发急性心包填塞诊治中的应用研究

目的:探讨超声引导下心包置管引流技术在心脏介入术并发急性心包填塞中的应用价值。方法:对本院在心脏介入术中由超声心动图或X线透视证实的40例并发急性心包填塞患者的临床资料进行分析。结果:40例患者中,显效20例(50%);有效12例(30%);无效8例,其中3例死亡;5例送胸外科行急诊开胸手术治疗。总有效率=显效率+有效率=80%。结论:在保证操作规范的前提下,超声引导下心包置管引流是治疗急性心包填塞的有效方法,具有重要的临床应用价值。     

后颅窝手术后颈枕部局部积液15例防治分析

目的:探讨后颅窝手术后颈枕部局部积液的预防和治疗。方法:对15例后颅窝术后出现颈枕部积液患者的临床资料进行回顾性分析。15例患者均在颈枕部积液腔留置外引流管,其中5例通过放置外引流管积液消失;10例在单纯放置外引流管无效后联合放置腰大池外引流,6例积液消失,4例最终进行二次手术。结果:经治疗,15例患者无发热、头痛等临床症状,颈枕部局部积液消失。结论:术中认真仔细操作是减少积液发生的关键,对于出现积液的患者,联合多种方法进行治疗,可以取得良好效果。     

Survival of 2 extreme preterm neonates with cardiac tamponade as a complication of percutaneous central venous catheterization

We report 2 extreme preterm neonates who developed cardiac tamponade secondary to perforation of the myocardium by the percutaneous silastic central venous catheters, which were inserted for parental nutrition. Percutaneous pericardiocentesis was performed and pericardial effusion was aspirated, later proved by analysis to be total parental nutrition. The lines were removed and the patients successfully resuscitated and survived, both were sent home in good condition.     

IL-2联合顺铂治疗恶性胸腔积液的有效性及安全性Meta分析

目的 评价IL-2(白细胞介素-2)联合顺铂对比顺铂治疗恶性胸腔积液的有效性及安全性.方法 计算机检索Pubmed、The Cochrane Library、Web of Science、Embase、中国知网、维普全文数据库和万方数据库.研究者筛选文献、提取数据并评价文献质量,采用RevMan 5.3软件进行Meta分析.结果 共纳入16项随机对照研究、894例患者.Meta分析结果显示:IL-2联合顺铂治疗恶性胸腔积液的有效率、完全缓解率、生活质量改善率明显高于单独用顺铂.不良反应中IL-2联合顺铂发热发生率高于单独应用顺铂,而胸痛、消化道反应、骨髓抑制的发生率两组比较差异无统计学意义(P>0.05).结论 IL-2联合顺铂治疗恶性胸腔积液的疗效、生存质量改善均明显优于单独用顺铂,仅发热发生率较单用顺铂高,有一定的临床推广应用价值,但须采取一定的措施预防不良反应的发生.