A New Approach to Percutaneous Subclavian Venipuncture to Avoid Lead Fracture or Central Venous Catheter Occlusion

Pacemaker and defibrillator leads and central venous catheters placed by commonly recommended techniques have been found to pass through the subclavius muscle, the costocaracoid ligament, or the costoclavicular ligament before entering veins medial to the first rib. Entrapment by these soft tissues subjects leads and catheters to stresses imposed by movements of the ipsilateral upper extremity. Accordingly, a new approach has been developed that introduces the lead or catheter into the subciavian vein near the lateral border of the first rib. This placement avoids soft tissue entrapment and may extend the longevity of leads and catheters.     

Physiological Effects of Mental Stress and Orthostasis in Young Insulin-Dependent Diabetic Patients

ABSTRACT. The effects of procedures which stimulate sympathetic activity, viz. mental stress induced by a colour-word conflict test (CWT) for 20 min, and orthostasis (ORT) for 8 min were studied in 8 young (16-20 yr) insulin-dependent diabetes mellitus (IDDM) patients and 9 age and sex-matched healthy controls. The IDDM patients showed no signs of neuropathy or retinopathy and their mean HbA_1c value was 8.4 ±0.6% (normal value < 5.0 %). Blood pressure and heart rate increased significantly during CWT and ORT in both groups. The changes in systolic blood pressure and heart rate were comparable in both groups during CWT; the IDDM group showed a higher ( p < 0.05) heart rate after 8 min of orthostasis, however. CWT and ORT elicited equivalent increases in noradrenaline in venous plasma in both groups ( p < 0.05), but the IDDM patients had 50% lower values ( p < 0.01) at rest, during CWT and at rest after CWT than controls. CWT and ORT evoked equivalent plasma adrenaline increases in both groups. The lipolysis marker, plasma glycerol, was about 40 % lower ( p < 0.05) in the IDDM group before and after CWT. Yet, mental stress evoked equivalent increases in glycerol levels ( p < 0.01) in both groups. These findings indicate that sympathetic activity in the young diabetic patients without signs of neuropathy may be blunted.     

Expectant management of deep cerebral venous thrombosis with intraventricular hemorrhage

Limited randomized clinical trial data favor the use of anticoagulation in patients with cerebral venous thrombosis. We present a patient with deep cerebral venous thrombosis in whom anticoagulation was withheld because of coexistent intraventricular hemorrhage. She had a benign clinical course without anticoagulation, suggesting that close observation may be a management option in these patients.     

Unique variant of partial anomalous pulmonary venous connection with intact atrial septum

Summary Partial anomalous pulmonary venous connections (PAPVCs) are rare in association with an intact atrial septum. However, the diagnosis should be considered in patients with otherwise unexplained findings of left-to-right shunt and right heart enlargement. An unusual variant is presented, which we considered unsuitable for operative repair, based on findings at catheterization. Developmental, hemodynamic, and surgical considerations are discussed.     

同型半胱氨酸及抗磷脂抗体与深静脉血栓形成和复发关系的研究

目的通过检测深静脉血栓形成（DVT）患者血浆中的同型半胱氨酸（Hey）和抗磷脂抗体（APLA）水平，探讨DVT形成和复发的因素，并寻找DVT复发的预报因子。方法选取2001年1月至2003年4月期间哈尔滨医科大学附属第二医院血管外科收治的60例DVT患者，其中初发组和复发组各30例，另随机选取门诊就诊经证实无DVT的下肢静脉曲张或深静脉功能不全的30例患者作为对照组，同时选取复发DVT的一级亲属组30例。用荧光偏振免疫法测定Hey，用酶联免疫吸附试验（ELISA）检测APLA中的抗心磷脂抗体（AcLA）水平（IgG、IgM型）并测定狼疮抗体（LA）阳性率。结果初发与复发DVT组患者血浆中的Hey和ACLA-IgG及ACLA-IgM水平均高于对照组和复发DVT一级亲属组，差异有统计学意义（P〈0．01）。复发DVT的一级亲属组的血浆中的Hey水平高于对照组（P〈0．05）。各组的LA阳性率差异无统计学意义（P〉0．05）。结论DVT患者血浆中Hey和APLA均升高，Hey和APLA与深静脉血栓形成有密切关系。Hey升高与DVT复发有关，可能是DVT复发的预报因子。     

胰头静脉弓的16层CT研究

目的探讨16层CT的各种血管成像方法对胰头静脉弓的正常表现及显示率方法对40例非腹部疾病患者行胰腺静脉期扫描,使用轴位图像、薄层最大密度投影(TSMIP)和容积再现(VR)图像分别评价胰头静脉弓的表现及显示率结果轴位图像、TSMIP和VR显示胃网膜右静脉均为100%,胃结肠干均为80%,右结肠上静脉分别为100%、87.5%、80%;胰十二指肠上后静脉分别为92.5%、65%、40%;胰十二指肠上前静脉分别为92.5%、62.5%、45%结论使用16层CT,联合轴位、TSMIP和VR图像可以清楚显示胰头静脉弓     

An uncommon cause of acute right ventricular failure and high mixed venous oxygen saturation

Ruptured sinus of Valsalva aneurysms are rare. We report a case in which the usual clinical manifestations were not present and the patient was initially treated as an acute pulmonary embolus. Despite three negative echocardiograms an intra-cardiac shunt was suspected because of a persistently elevated mixed venous oxygen saturation. Cardiac catheterisation confirmed the diagnosis. Surgical repair was performed and post operative recovery was uneventful.     

华法林在我国治疗静脉血栓栓塞性疾病的最优抗凝区间

目的 前瞻性研究我国静脉血栓栓塞性疾病(VTE)患者不同华法林抗凝强度区间的出血率和VTE复发率及寻找最优国际标准化比值(INR)区间.方法 将2006年10月至2007年7月间安贞医院收治的180例VTE患者作为研究对象,随机分成A、B、C 3组,每组各60例,分别对应INR目标区问是1.50～1.99(低强度抗凝组)、2.00～2.50(中等强度抗凝组)及2.51～3.00(高强度抗凝组).INR稳定在目标区间2周以上后,开始正式观察每组大、中、小量出血率及VTE复发率.研究者及观察对象均遵循盲法原则.结果 低强度组与中高强度组的复发率分别为8.3%、1.7%(P=0.042).低、中、高强度抗凝3组间少量出血率分别为8.3%、18.3%及6.7%(P=0.089);低与中高强度组中量出血率分别为3.3%、7.5%(P=0.341);低与中高强度组大量出血率分别为0%、3.3%(P=0.303).62岁以上人群,中低强度组大出血(1例)与高强度组(3例)相比(即INR从1.5～2.5增加到2.51～3.00),危险比为12.600(95%可信区间为1.183～134.238).结论 对于一般中国人.华法林抗凝INR在2.0～3.0之间既能减少VTE复发风险又不增加出血风险,故INR应推荐在2.0～3.0之间.对于年龄62岁以上的高龄人群,INR应推荐在2.0～2.5之间.     

Percutaneous transluminal coronary angioplasty in a patient with paroxysmal nocturnal hemoglobinuria

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired chronic hemolytic anemia associated with an unusual susceptibility to hemolytic crisis, infection, and venous thrombosis which would be aggravated by a number of factors including surgery. We report a case of PNH undergoing percutaneous transluminal coronary angioplasty and discuss the corresponding perioperative management.