Primary gastric signet ring cell carcinoma presenting as cardiac tamponade

Primary gastric signet ring cell carcinoma presenting as cardiac tamponade is difficult to diagnosis early.Patients are generally asymptomatic until the disease is advanced.General practitioners usually focus on the initial symptoms related to pericarditis and pericardial effusion.We report a case of signet-ring cell carcinoma of the stomach presenting as cardiac tamponade with pericarditis and pericardial effusion but without any gastrointestinal symptoms.A 49-year old woman was admitted because of progressive dyspnea and cough.Chest X-ray revealed an increased cardiothoracic ratio and a small amount of bilateral pleural effusion.Two dimensional ultrasonographic echocardiography pericardial effusions with atrial and right ventricular early diastolic collapse were found,establishing the diagnosis of cardiac tamponade.Pericardiocentesis was performed and 420 mL of bloody fluid was taken.The patient died of respiratory failure and cardiac arrest on October 28,2009.Post-mortem examination revealed diffuse gastric mucosa erosion and edema with stomach mucosa incrassation in the greater curvature.The primary lesion was histopathologically diagnosed as signet-ring cell carcinoma of the stomach.     

慢性缩窄性心包炎的外科治疗体会

目的探讨慢性缩窄性心包炎的外科手术治疗体会。方法回顾性的分析我科在2004～2008年期间对80例慢性缩窄性心包炎而进行心包剥脱术的患者,并对术前术后的心功能评分进行比较分析。结果本组80例均成功剥离心包,中心静脉压明显下降,手术成功康复出院。患者术前术后的心功能评级的差异有统计学意义。结论心包剥术是治疗慢性缩窄性心包炎有效安全的治疗方法,充足的术前准备和术后监测是降低患者死亡率,提高手术效果的重要途径。     

急性心包炎的临床诊断与治疗

心包炎是临床常见病,其病因可分为感染性和非感染性两大类,心包炎的临床表现多种多样,近些年尽管在心包炎的治疗上取得了一些进展,但因循证医学证据的缺乏,目前临床上心包炎的诊治仍是以经验治疗为主。急性心包炎的自然病程往往呈自限性。预后较好,所以治疗上以支持疗法为主。     

IgG4-related disease manifesting as pericarditis with elevated adenosine deaminase and IL-10 levels in pericardial fluid

A 78-year-old female with massive pericardial effusion fulfilled diagnostic criteria for immunoglobulin G4 (IgG4)-related disease. Although her adenosine deaminase (ADA) level in the pericardial effusion was high, all the tests for tuberculosis infection were negative. Immunostaining of the pericardium biopsy specimen revealed remarkably increased IgG4-positive cells. This is the first report describing IgG4-related pericarditis with elevated ADA level. We also demonstrate the elevated interleukin-10 (IL-10) level in pericardial fluid and IL-10-producing T-cells in the pericardium.     

慢性缩窄性心包炎的影像学特征分析

目的:提高对慢性缩窄性心包炎的临床及影像学特征的认识能力,降低误诊率.方法:分析41例慢性缩窄性心包炎的临床表现,影像学特征.结果:临床表现为不同程度的呼吸困难、心悸、浅静脉充盈,心尖搏动减弱、奇脉、脉压差小.影像学表现:超声心动图检查:心室舒张末径缩小者33例,24例于M型超声心动图上见左室后壁在舒张中晚期运动停止呈平直外形.X线检查:心影轻中度扩大者32例,25例出现心包钙化,26例出现肺淤血,肺部有结核病灶者23例.CT可明确显示心包增厚及钙化.结论:慢性缩窄性心包炎的影像学特征是一侧或两侧心缘僵直,搏动减弱,心包膜增厚、钙化,心室缩小,小心室大静脉.     

缩窄性心包炎的影像学诊断现状及进展

缩窄性心包炎(CP)是由于病变心包限制心脏舒张而导致的全身血液循环障碍的疾病,其临床表现缺乏特异性,诊断较困难,而影像学检查以其无创、高敏感性及重复性好等优点已成为诊断CP的主要方法,本文就不同影像学检查方法在CP中的应用现状及进展进行综述。     

Myocarditis and pericarditis: Case definition and guidelines for data collection,analysis, and presentation of immunization safety data

Myocarditis and/or pericarditis (also known as myopericarditis) are inflammatory diseases involving the myocardium (with non-ischemic myocyte necrosis) and/or the pericardial sac. Myocarditis/pericarditis (MPC) may present with variable clinical signs, symptoms, etiologies and outcomes, including acute heart failure, sudden death, and chronic dilated cardiomyopathy. Possible undiagnosed and/or subclinical acute myocarditis, with undefined potential for delayed manifestations, presents further challenges for diagnosing an acute disease and may go undetected in the setting of infection as well as adverse drug/vaccine reactions.The most common causes of MPC are viral, with non-infectious, drug/vaccine associated hypersensitivity and/or autoimmune causes being less well defined and with potentially different inflammatory mechanisms and treatment responses. Potential cardiac adverse events following immunization (AEFIs) encompass a larger scope of diagnoses such as triggering or exacerbating ischemic cardiac events, cardiomyopathy with potential heart failure, arrhythmias and sudden death. The current published experience does not support a potential causal association with vaccines based on epidemiologic evidence of relative risk increases compared with background unvaccinated incidence. The only evidence supporting a possible causal association of MPC with a vaccine comes from case reports.Hypersensitivity MPC as a drug/vaccine induced cardiac adverse event has long been a concern for post-licensure safety surveillance, as well as safety data submission for licensure. Other cardiac adverse events, such as dilated cardiomyopathy, were also defined in the CDC definitions for adverse events after smallpox vaccination in 2006. In addition, several groups have attempted to develop and improve the definition and adjudication of post-vaccination cardiovascular events. We developed the current case definitions for myocarditis and pericarditis as an AEFI building on experience and lessons learnt, as well as a comprehensive literature review. Considerations of other etiologies and causal relationships are outside the scope of this document.