Acute myocardial infarction after blunt chest trauma in young people: Need for prompt intervention

We describe four cases of acute myocardial infarction in young patients, secondary to blunt chest trauma. One case was treated with intracoronary thrombolysls and angioplasty, two cases received systemic thrombolysis, and the last one did not have any reperfusion therapy. The coronary angiograms of the left anterior descending artery showed thrombosis in two cases, coronary dissection in one case, and no morphological lesions in the other. We encourage the early performance of angiographic studies in these patients, adjusting the therapy to their pathophysiologic mechanism.     

Low molecular weight heparin (Fragmin(R)) prevents early reocclusion following femoral artery thrombolysis with rt-PA in rabbits

The purpose of this study was to evaluate the effect of lowmolecular weight heparin Fragmin on thrombolysis with tissue-typeplasminogen activator (rt-PA) and to compare its effect to thatof standard heparin. A rabbit thrombosis model was used, consistingof a blood clot produced in an isolated femoral artery segmentwith superimposed endothelial damage and distal stenosis. Thirtyrabbits were randomized to three treatment groups with rt-PA(30 µ.g. kg^–1. min^–1 for 60 min and no additionaltherapy), rt-PA with Lv. standard heparin (200 IV. Kg^–1bolus and then 70 IU. Kg^–1 hourly) and rt-PA with s.c.Fragmin (a single dose of 500 IU. Kg^–1) prior to rt-PAadministration. In six of 10 rabbits given rt-PA only, recanalizationwas observed, which was persistent in three. In eight of 10rabbits given rt-PA with intravenous heparin, reflow was achieved,which was persistent in three. Fragmin resulted in recanalizationin eight of 10 rabbits, with persistent patency in each recanalizedrabbit. Reflow time was not shortened with either standard heparinor Fragmin compared with rt-PA alone (64±41, 56 ±18, 50 ±23 min respectively), (P=0·7). Persistentreocclusion after reflow was not observed with Fragmin (0/8)but was present with both standard heparin (518, P=0·03vs Fragmin) and rt-PA alone (316, P=0·05 vs Fragmin). Thus, in the femoral artery of the rabbit, Fragmin, unlike standardheparin, was found to prevent reocclusion following rt-PA thrombolysis.     

放疗联合动脉化疗栓塞及酪氨酸激酶抑制剂治疗肝癌合并瘤栓的长期结果

目的 探讨调强放疗联合动脉化疗栓塞及酪氨酸激酶抑制剂（tyrosine kinase inhibitor,TKI）治疗肝细胞性肝癌合并静脉瘤栓患者的长期随访结果。方法 回顾性分析2015年10月至2018年10月北京大学肿瘤医院收治的63例肝细胞性肝癌合并静脉瘤栓且无远处转移患者,其中28例接受调强放疗联合动脉化疗栓塞及索拉非尼（A组）,35例接受调强放疗联合动脉化疗栓塞（B组）。采用倾向评分配比法,分析联合与不联合索拉非尼组的治疗疗效。结果 中位随访时间62个月。A组和B组的中位生存时间分别为19.0和15.2个月（χ²=3.15,P=0.076）,A组的中位无进展生存时间为10.7个月,高于B组的8.6个月（χ²=3.99,P=0.046）。经过倾向评分配比平衡组间差异后,A组的中位生存时间为30.6个月,明显高于B组的15.2个月（χ²=5.34,P=0.023）;A组的中位无进展生存时间12.5个月,仍然高于B组的8.3个月（χ²=4.79,P=0.026）。全组10例（15.9%）患者治疗中出现3级血液学毒性,7例（11.1%）患者出现3级肝功能异常。A组较B组的皮肤反应、手足综合征和腹泻发生率高,但均为1~2级不良反应。全组无4级不良反应,无放射诱发肝病及治疗相关死亡发生。结论 长期随访结果显示,肝细胞性肝癌合并静脉瘤栓患者在调强放疗加动脉化疗栓塞的基础上联合TKI提高了疗效。     

急性心肌梗死冠状动脉内血栓溶解治疗与再灌注性心律失常

２２例急性心肌梗死患者接受经皮冠状动脉内血栓溶解治疗，经即刻冠状动脉造影证实１４例冠状动脉再通。９例（６４．３％）发生再灌注性心律失常（ＲＡ）。１４例中７例（５０．０％）为室性ＲＡ，３例（２１．４％）发生加速性室性自主节律，后者为提示再灌注的特异性较高的指标。一过性缓慢性心律失常的５例（３５．８％）均发生在下壁及（或）后壁梗死。ＲＡ的发生与再灌注前心肌缺血时间和缺血性心律失常存在与否无关，心肌功能严重受损患者可能更易发生ＲＡ。本文并就如何预防和治疗ＲＡ进行了探讨。     

房间隔缺损封堵术前后心肌损伤的变化

目的:探讨房间隔缺损(ASD)患者介入治疗前后心肌肌钙蛋白I(cTnI)的变化规律。方法:42例ASD患者(ASD组)、16例诊断性导管介入的先天性心脏病患者(诊断性导管介入组)用酶联免疫吸附(ELISA)法检测介入前后不同时间点血清cTnI的水平。结果:所有患者术前血清cTnI水平处于正常值范围内;术后即刻、4 h及24 h,ASD组较术前升高,诊断性导管介入组与术前无差异,两组间有显著统计学意义(P<0．01);72 h两组间无显著统计学意义(P>0．05)。结论:ASD的介入治疗引起可逆性的心肌微损伤,是一种安全、有效、创伤小的方法。     

Effect of verapamil on systolic and diastolic coronary blood flow velocity in asymptomatic and mildly symptomatic patients with hypertrophic cardiomyopathy

OBJECTIVE: To assess non-invasively the effect of verapamil treatment on coronary blood flow velocity in asymptomatic and mildly symptomatic patients with hypertrophic cardiomyopathy. DESIGN: High frequency transthoracic Doppler echocardiography was used to compare resting phasic coronary blood flow velocity before and after a one month period of verapamil treatment in 17 patients (14 men and three women) with non-obstructive hypertrophic cardiomyopathy. Eighteen healthy subjects formed an age and sex matched control group. Systolic and diastolic coronary blood flow velocity was measured in the distal portion of left anterior descending coronary artery using high frequency transthoracic Doppler echocardiography. Blood flow velocity before and after verapamil was compared in the patients with cardiomyopathy and with the results in the control group. RESULTS: Compared with the controls, patients with hypertrophic cardiomyopathy had increased diastolic coronary blood flow velocity (41.8 (8.1) v 59.9 (21.9) cm/s, p < 0.01) and a lower mean systolic coronary blood flow velocity (18.7 (10.8) v -11.2 (27.5) cm/s, p < 0. 01) before verapamil treatment. A backward pattern of systolic flow, manifested by negative values of coronary blood flow velocity, was recorded in eight of the patients, while no negative values were found in the controls. After verapamil treatment the retrograde systolic blood flow was restored to an anterograde pattern in only one patient. The mean value of systolic coronary blood flow velocity did not change significantly and remained lower than the systolic forward flow velocity in the controls (-3.6 (31.8) v 18.7 (10.8) cm/s, p < 0.05). However, diastolic coronary blood flow velocity decreased significantly after verapamil (59.9 (21.9) v 50.7 (19.5) cm/s p < 0.05), reaching a level comparable with that in the controls (50.7 (19.5) v 41.8 (8.1) cm/s, p > 0.05). CONCLUSIONS: In contrast to healthy subjects, in non-obstructive hypertrophic cardiomyopathy the systolic pattern of coronary blood flow was heterogeneous (both retrograde and anterograde), and diastolic coronary blood flow velocity was abnormally increased, despite a lack of significant symptoms. Verapamil treatment did not restore the forward pattern of systolic blood flow but decreased diastolic blood flow velocity to a level comparable with that in healthy subjects.     

房间隔缺损封堵治疗中Amplatzer封堵器的非常规方法选择

目的 :研究非常规方法选择 Amplatzer房间隔缺损封堵器的可行性。方法 :患者 15 8例 ,年龄 1～ 6 5 （2 7士 19）岁。其中常规组 4 1例 ,非常规组 117例。非常规组按照选择封堵器的最终依据不同 ,分为 3组。A组 :33例 ,根据食道超声心动图 （TEE）测量的 ASD最大径直接选择封堵器 ;B组 :4 6例在经胸超声心动图 （TTE）监测指导下球囊充盈测量 ASD伸展径 （BSD） ,根据 BSD选择封堵器 ;C组 :38例 ,根据 TTE测量的 ASD最大径直接选择封堵器。结果 :各组患者 ASD的边缘、大小和选择封堵器的大小之间均无显著性差异 （P>0 .0 5 ）。各组技术成功率均为10 0 %。非常规各组完全闭合率与常规组无显著性差异 （P>0 .0 5 ） ,但手术操作时和 （或 ）透视时间均明显短于常规组 （P<0 .0 1）。结论 :非常规法选择 Amplatzer封堵器对大部分 ASD介入治疗是安全可行的。对于房缺周缘较长、较硬者 ,及边缘为硬缘和极软缘组成而剔除极软缘者 ,TEE或 TTE可直接指导 Amplatzer封堵器型号的选择。对于房缺缘较软者 ,应结合球囊测量房缺伸展径选择封堵器     

Mid-term results of transcatheter closure of ventricular septal defect using Nit-Occlud Lê ventricular septal defect coil,single-center experience

Objectives

To assess safety, efficacy and follow-up results of transcatheter closure of ventricular septal defect (VSD) using Nit-Occlud_ Lê VSD Coil (pfm medical, KÖln, Germany).