Rotational angiography in monitoring of covered CP stent implantation in patient with critical aortic coarctation and patent ductus arteriosus

In presented case rotational angiography with three dimensional reconstruction (3DRA) was used for diagnostic and control angiograms during covered CP stent implantation in patient with critical aortic coarctation and patent ductus arteriosus. Administering less contrast then for standard two perpendicular projections, good quality images were obtained in at least seven projections.     

Guidance on the emergent reversal of oral thrombin and factor Xa inhibitors

The new oral anticoagulants dabigatran, rivaroxaban and apixaban have advantages over warfarin which include no need for laboratory monitoring, less drug-drug interactions and less food-drug interactions. However, there is no established antidote for patients who are bleeding or require emergent surgery and there is a paucity of evidence to guide the clinical care during these situations. Members of thrombosis and anticoagulation groups participating in the Thrombosis and Hemostasis Summit of North America formulated expert opinion guidance for reversing the anticoagulant effect of the new oral anticoagulants and suggest: routine supportive care, activated charcoal if drug ingestion was within a couple of hours, and hemodialysis if feasible for dabigatran. Also, the pros and cons of the possible use of four factor prothrombin complex concentrate are discussed.     

前白蛋白变化率对肝衰竭预后的预测作用

目的探讨血清前白蛋白(PALB)变化率与肝衰竭预后的关系。方法回顾性分析98例肝衰竭患者的临床资料,对患者进行Child-Pugh分级,并把患者分为好转组与未愈组,收集住院期间初始及末次PALB及其他主要肝功能指标的数值,并计算出PALB及其他主要肝功能指标的变化率。结果入院时患者的初始PALB数值明显下降,且Child-Pugh分级越高,数值越低。好转组与未愈组患者的初始PALB数值相近,当血清PALB数值快速升高时,好转组人数明显多于未愈组;当数值下降时,好转组人数明显少于未愈组;当数值升高不明显时,未愈组与好转组差异无统计学意义,但未愈组人数要多于好转组。PALB变化率的敏感度最高,特异度较总胆红素、凝血酶原活动度、国际标准化比值变化率低,而ROC曲线下面积最大。结论肝衰竭患者初始PALB明显比正常值低,而且病情越重,血清中PALB数值越低,但患者预后与初始PALB无相关性,而与PALB变化率相关。大部分PALB快速升高者,预后好;大部分PALB下降或升高缓慢者,预后差。而且PALB变化率对于预后的预测价值要高于其他主要肝功能指标。     

胎儿超声心动图诊断左心发育不良综合征13例报道

目的:探讨应用胎儿超声心动图对左心发育不良综合征(HLHS),诊断方法及诊断价值。方法:对胎儿超声心动图检出的13例HLHS胎儿的超声资料与病理解剖结果对照,分析胎儿超声心动图诊断要点。结果:经病理证实为HLHS 13例,均与超声诊断结果一致,超声诊断正确率100%。13例HLHS患儿中,Ⅰ型2例(15.4%),Ⅱ型5例(38.4%),Ⅲ型2例(15.4%),Ⅳ型4例(30.8%)。超声提示13例均显示左、右心系统比例极端不对称,左心室小、发育不良,右心系统比例增大,主肺动脉内径比例失调,主肺动脉血流方向呈反向。结论:产前胎儿超声心动图作为一种安全、便捷、经济及有效的检查方法,对胎儿左心发育不良综合征的检出具有重要的价值。