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91.
Anne S. Chin Martin J. Willemink Aya Kino Virginia Hinostroza Anna M. Sailer Michael P. Fischbein R. Scott Mitchell Gerald J. Berry D. Craig Miller Dominik Fleischmann 《Journal of the American College of Cardiology》2018,71(24):2773-2785
Background
Limited intimal tears (LITs) of the aorta (Class 3 dissection variant) are the least common form of aortic pathology in patients presenting with acute aortic syndrome (AAS). LITs are difficult to detect on imaging and may be underappreciated.Objectives
This study sought to describe the frequency, pathology, treatment, and outcome of LITs compared with other AAS, and to demonstrate that LITs can be detected pre-operatively by contemporary imaging.Methods
The authors retrospectively reviewed 497 patients admitted for 513 AAS events at a single academic aortic center between 2003 and 2012. AAS were classified into classic dissection (AD), intramural hematoma, LIT, penetrating atherosclerotic ulcer, and rupturing thoracic aortic aneurysm. The prevalence, pertinent risk factors, and detailed imaging findings with surgical and pathological correlation of LITs are described. Management, early outcomes, and late mortality are reported.Results
Among 497 patients with AAS, the authors identified 24 LITs (4.8% of AAS) in 16 men and 8 women (17 type A, 7 type B). Patients with LITs were older than those with AD, and type A LITs had similarly dilated ascending aortas as type A AD. Three patients presented with rupture. Eleven patients underwent urgent surgical aortic replacement, and 2 patients underwent endovascular repair. Medial degeneration was present in all surgical specimens. In-hospital mortality was 4% (1 of 24), and in total, 5 patients with LIT died subsequently at 1.5 years (interquartile range [IQR]: 0.3 to 2.5 years). Computed tomography imaging detected all but 1 LIT, best visualized on volume-rendered images.Conclusions
LITs are rare acute aortic lesions within the dissection spectrum, with similar presentation, complications, and outcomes compared with AD and intramural hematoma. Awareness of this lesion allows pre-operative diagnosis using high-quality computed tomography angiography. 相似文献92.
93.
94.
Glória Abreu Carlos Galvão Braga João Costa Pedro Azevedo Jorge Marques 《Revista portuguesa de cardiologia》2018,37(8):707-713
Background
Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute coronary syndrome (ACS). Better recognition and diagnosis has raised awareness of this condition. However, the pathophysiology of SCAD and its prognosis are still little understood. We aimed to investigate the characteristics and prognosis of patients with SCAD, and subsequently performed a review of literature.Methods
Single-center, retrospective study performed in patients hospitalized from January 2010 to December 2016 with suspected ACS (n=5002) whose final diagnosis was SCAD (n=27; 0.5%).Results
Patients with SCAD were mainly female (81.5%; n=22), with median age of 56. Predisposing factors were identified in 12 (44%) patients and precipitating factors in three (11.1%). Non-ST elevation myocardial infarction (NSTEMI) was the main form of presentation (51.9%). The left anterior descending artery (LAD) territory was the most commonly involved (n=12, 44.4%). Type 2 dissection was the most prevalent angiographic pattern (n=17, 63%). The majority of patients (n=15; 55.6%) were managed medically and the remaining patients underwent percutaneous coronary intervention (PCI) with drug-eluting stents. Seven patients re-infarcted while in the hospital. Over the median follow-up period of 20 months, 7.4% of patients (n=2) had symptoms of heart failure (HF) and 14.8% developed ACS (in three patients the event occurred in a coronary territory other than that of the index case, and in one patient it occurred in the previously affected territory). There were no deaths.Conclusion
In the studied population, SCAD was more prevalent in middle-aged women. Despite the high prevalence of in-hospital re-infarction or during follow-up, the prognosis was good overall. 相似文献95.
目的探讨外伤性硬膜下积液形成机制及治疗。方法回顾性分析27例外伤性硬膜下积液患者的临床资料,术中通过采用脑室镜观察假膜腔、病理特点和对手术组和非手术组脑容积变化进行分析后推测硬膜下积液机制,根据推测机制采用小骨窗开颅明胶海绵填塞增加假膜壁层脏层粘连而消灭死腔治疗硬膜下积液,术前术后对IL-6和IL-8检测评价手术效果。结果脑中线移位、基底池受压两组比较差异有统计学意义(P0.05),脑萎缩、蛛网膜下腔出血两组比较差异未见统计学意义(P0.05),脑容积与硬膜下腔之间压力不平衡导致脑脊液通过撕裂蛛网膜进入硬膜下腔,采用小骨窗开颅明胶海绵填塞治疗慢性硬膜下积液有效率为93%,术后IL-6和IL-8因子浓度高于术前(P0.05),在长期随访中所有病例均未出现并发症。结论小骨窗开颅明胶海绵填塞增加假膜壁层脏层粘连治疗硬膜下积液是一种安全、简单、有效的方法。 相似文献
96.
Hirata N Kushida Y Ohguri T Wakasugi S Kojima T Fujita R 《Journal of gastroenterology》1999,34(6):713-716
We present a patient with complication of huge hepatic subcapsular hematoma after extracorporeal shock wave lithotripsy (ESWL)
for pancreatic lithotripsy. The hematoma measured 78–110 mm. Angiography showed a subcapsular hematoma, rather than a hematoma
in the liver. In the arterial phase, the distal end of the small vessel showed spotty opacification similar to microaneurysma,
suggesting that it was an injury caused by separation of the liver and its capsule, caused by the shock waves. The portal
vein and hepatic vein were normal. After 8 weeks of conservative therapy, the hematoma was gradually absorbed and the patient
was discharged. Eight months after the accident, the hematoma had decreased to 40 mm in size. After 20 months, it was completely
absorbed. The reported rate of renal subcapsular hematoma after ESWL for renal or ureter stones is 0.1%–0.7%. To date, however,
only five cases of hepatic subcapsular hematoma after right renal stone disintegration have been reported. This is the first
report of hepatic subcapsular hematoma after ESWL for pancreatic stones.
Received: September 11, 1998 / Accepted: April 16, 1999 相似文献
97.
冠状动脉介入术后腹膜后血肿的危险因素研究 总被引:6,自引:0,他引:6
目的探讨冠状动脉介入术(PCI)后腹膜后血肿(RPH)的发生率、临床特征和危险因素。方法对北京安贞医院心内科2000-01—2005-09共3729例经股动脉穿刺进行PCI术的病例进行回顾性分析,其中并发RPH的21例设为观察组,选择另外30例未发生RPH的病例设为对照组。采用单因素和多因素分析RPH发生的危险因素。结果RPH的发生率为0·6%。RPH最常见的临床特征为贫血(100%),其余还包括低血压(95%)、出汗(57%)、腹股沟痛(48%)、下腹痛(38%)和背痛(38%)。RPH的独立预测因素有3个:女性(OR=5·23,P<0·0001)、体表面积(BSA)<1·53m2(OR=7·11,P=0·005)和高部位股动脉穿刺(OR=5·42,P=0·001)。结论女性、低BSA和高部位股动脉穿刺是RPH发生的独立预测因素。 相似文献
98.
王琴 《国际病理科学与临床杂志》2015,(5)
目的:探讨早期康复护理措施对高血压脑出血颅内血肿清除术患者的应用效果。方法:回顾性分析我院2010年3月~2014年3月收治的120例高血压脑出血颅内血肿术患者临床资料,其中,自2010年3月~2012年3月收治的60例患者采用了常规护理措施,记为对照组;自2012年4月至2014年3月收治的60例患者则采取了早期康复护理措施,记为观察组。比较两组患者的护理效果。结果:护理干预后,观察组患者的MBI、ESS及GCS评分均较对照组患者出现了明显改善,组间差异具有统计学意义,观察组患者术后并发症的发生率明显低于对照组患者,组间差异具有统计学意义。结论:早期康复护理措施对高血压脑出血颅内血肿清除术患者具有十分重要的意义,可有效改善患者的神经功能,促进患者日常生活能力的改善,从而改善患者的生活质量,促进患者的预后恢复,值得临床参考。 相似文献
99.
Qinghua Zhang Qianqian Tang Xianghua Li Jincun Li Liping Zhang Chuanzhu Yan Yuanxiao Cui 《International journal of clinical and experimental pathology》2015,8(5):5371-5378
This study was to investigate the effects of intracerebral hemorrhage (ICH) and subsequent minimally invasive hematoma aspiration on the expression of apoptosis-related genes in rats. IV-collagenase was injected to the caudate nucleus of the rats to make ICH models. In the control group, 30 Sprague-Dawley (SD) rats were mock treated with saline instead of collagenase. Thirty SD rats with successful modeling were designated as the ICH group. Twenty-five SD rats with successful modeling and subsequent minimally invasive hematoma aspiration were designated as the therapy group. Expression of heat shock protein 70 (Hsp70), B-cell leukemia/lymphoma 2 (Bcl-2) and Bcl-2-associated X protein (Bax) in the brain tissues was detected by immunohistochemical assays. The expression of Hsp70, Bcl-2 and Bax in the control group was very low, and significantly increased in the ICH group and the therapy group. At each indicated time point, Hsp70 expression in the therapy group was significantly lower than that of the ICH group, Bax expression in the therapy group was significantly lower than that of the ICH group and Bcl-2 expression in the therapy group was significantly higher than that of the ICH group. These results suggest that ICH led to increased expression of apoptosis-related genes in the brain tissues. Hematoma aspiration up-regulated ICH induced Bcl-2 expression while down-regulated ICH induced Hsp70 and Bax expression. 相似文献
100.