中心静脉导管留置治疗结核性心包积液的临床评价

目的探讨中心静脉导管留置引流在治疗结核性心包炎伴有大量心包积液的应用价值。方法将76例结核性渗出性心包炎患者随机分为A组和B组,均予以全身规则抗结核治疗。A组留置中心静脉导管引流及心包腔内注药,B组常规心包穿刺抽液及心包腔内注药。结果A组与B组相比,两组间在消除心包填塞症状时间,退热时间,心包积液消失时间等方面有显著性差异(P＜ 0．01)。结论心包穿刺留置导管引流心包积液安全可行,操作简便,可迅速消除心包填塞症状,能及时彻底引流心包积液,疗效明显,降低了缩窄性心包炎的发生率。     

老年人缩窄性心包炎的特点

目的探讨老年人缩窄性心包炎的临床特点,并与非老年人比较。方法回顾性总结我院2000—2007年连续诊断的缩窄性心包炎患者门诊与住院资料,对60岁以上老年患者与非老年患者临床与病理情况进行比较分析。结果 150例中,48例为老年人,占32.0%,非老年人102例。结核分别占83.3%和76.5%(P>0.05)。老年人胸痛、呼吸困难的发生率和心包积液检出率均高于非老年人,分别是87.5%比59.8%(P=0.0006),79.2%比52.0%(P=0.0074),腹腔积液发生率老年人明显低于非老年,分别是32.2%比52.9%(P=0.0129),结核性腹膜炎发生率为6.3%比35.2%(P=0.0456);心律失常在两组各为6例,但老年组的心律失常均为持续不可逆的;老年组32例(66.7%)存在62种合并症,非老年组仅13例(12.8%)存在合并症(P<0.001);老年组心包剥脱手术率明显低于非老年组(56.3%比80.4%,P=0.002),70岁以上手术治疗率仅25.9%;病死率两组相似,分别为6.3%比9.8%(P>0.05)。结论老年人缩窄性心包炎发病率不低,结核也是老年人缩窄性心包炎的最常见病因;临床表现与非老年人比较有一定特殊性,合并症多,心包剥脱手术率随年龄增长下降;病死率、近期预后与非老年人相似。     

Pericarditis and pleuritis associated with human parvovirus B19 infection in a systemic lupus erythematosus patient

Abstract

Human parvovirus B19 (PVB19) infection sometimes shows systemic lupus erythematosus (SLE)-like symptoms. We present an SLE patient showing pericarditis and pleuritis with a fever and an acute swelling of extremities 2 months after the fist consultation. Initially, a diagnosis of SLE exacerbation was made. Additional laboratory examination showed positive results for immunoglobulin M (IgM) antibody to PVB19 and PVB19 DNA in serum and pleural effusion at that time. After 1 month, PVB19 DNA in serum and IgM antibody to PVB19 was negative. Based on these findings, a final diagnosis of PVB19 infection in an SLE patient was made. PVB19 infection should be taken into consideration for SLE with acute swelling of the extremities and fever, as these symptoms are often observed in adult cases of PVB19 infection. Steroid pulse therapy rapidly improved these symptoms, and later the dose of steroid was reduced to 5 mg/day of prednisolone. Thus, steroids may be one of the choices for severe and/or rapidly progressive symptoms of pericarditis and pleuritis due to PVB19 infection.     

Successful treatment with tocilizumab of pericarditis associated with rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is a systemic inflammatory disease often complicated by vasculitis. Pericarditis is a serious complication caused by vasculitis, resulting in retention of pericardial effusion that sometimes induces cardiac tamponade. We report a patient with RA in whom pericarditis improved after tocilizumab administration. A male patient was diagnosed with RA and chronic renal failure in 1980 and was treated with salazosulfapyridine, but disease activity remained high. In January 2012, at the age of 73 years, he developed organizing pneumonia as a complication and was admitted to our hospital. Treatment with prednisolone 30 mg/day was initiated. However, 20 days after initiation of treatment, chest pain and palpitation developed, and chest computed tomography (CT) and echocardiography (ECG) revealed retention of pericardial effusion without cardiac tamponade. Rheumatoid nodules and interstitial pneumonia were also observed, and serum C3 level was decreased. A diagnosis of pericarditis caused by vasculitis was made based on these findings, and tocilizumab 8 mg/kg was administered. His symptoms improved gradually, and chest CT and ECG showed no pericardial effusion after about 3 weeks. No adverse effects of tocilizumab were observed during the clinical course. Although there are only a few reports of the effects of tocilizumab on vasculitis associated with RA, tocilizumab administration appears worthwhile in RA patients with vasculitis who do not respond to conventional treatment.     

Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series

Objective:

In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular.

Methods:

We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity.

Results:

In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis.

Conclusions:

In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis.     

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目的分析缩窄性心包炎(CP)二种少见的超声表现及临床意义。方法1981-04-2004-04回顾分析广东省心血管病研究所187例CP患者的超声资料。重点观察左室射血分数(LVEF)及吸气相二尖瓣E峰(VEi)较呼气相(VEe)的下降率VER=(VEe-VEi)/VEe。结果大部分病人符合CP一般超声改变。但发现二种少见的超声征象。(1)14例(7.49%)CP患者LVEF<0.50(0.45±0.42)。心包钙化明显甚或嵌入心肌。(2)48例窦性心律CP患者行多普勒超声检查,10例(20.83%)VER<25%(均值14.84%)并见心包广泛粘连、挛缩、大片缩窄环形成。结论CP患者LVEF下降及二尖辩血流速度吸气相较呼气相下降<25%时,提示心包病变严重。范围广泛,应引起临床高度重视。     

Pericarditis and chronic inflammatory demyelinating polyneuropathy during therapy with pegylated interferon alfa-2a for chronic hepatitis C

We report a case of pericarditis and chronic inflammatory demyelinating polyneuropathy with biological signs of a lupus-like syndrome due to pegylated interferon alfa-2a therapy during treatment for chronic hepatitis C. The patient developed moderate weakness in the lower limbs and dyspnea. He was hospitalized for congestive heart failure. An electrocardiogram showed gradual ST-segment elevation in leads V(1) through V(6) without coronary artery disease. A transthoracic cardiac ultrasonographic study revealed moderate pericardial effusion with normal left ventricular function. Anti-DNA antibody and antids DNA IgM were positive. Neurological examination revealed a symmetrical predominantly sensory polyneuropathy with impairment of light touch and pin prick in globe and stoking-like distribution. Treatment with prednisolone improved the pericarditis and motor nerve disturbance and the treatment with intravenous immunoglobulin improved the sensory nerve disturbance.     

Pericarditis: a rare complication of methotrexate therapy

Serositis is a rare complication of methotrexate (MTX) administration. We report a 60-year-old man with rheumatoid arthritis who developed pericarditis after taking his weekly MTX dose, which recurred within hours after 2 subsequent weekly MTX doses. Pericarditis has not recurred after discontinuance of MTX over 3 years ago. We conclude that he had MTX-induced pericarditis, based on the close temporal relationship between MTX ingestion and manifestations of pericarditis on three distinct occasions because of the previous reports of MTX-induced pericarditis and because pericarditis has not recurred after MTX withdrawal.