Cardiac malignant tumor as a rare cause of acute myocardial infarction

Acute myocardial infarction is predominantly caused by coronary artery atherosclerotic plaque rupture and subsequent occlusive thrombus formation. The recognition of less common causes of acute myocardial infarction is important because they may require a different treatment strategy. We report a patient with acute myocardial infarction without any angiographic evidence of coronary atherosclerosis and a left atrial mass detected on echocardiography. Therefore, coronary embolism from intracardiac thrombus or tumor was suspected. No additional manifestations of a potential tumor were found on thoracic, abdominal and cranial computed tomography. During subsequent cardiac surgery, a large tumor could be in toto resected and was diagnosed as a highly malignant leiomyosarcoma on histopathological evaluation.     

Intracranial pressure changes following middle cerebral artery occlusion in rats

Prolonged recording of intracranial pressure (ICP) was performed on rats subjected to middle cerebral artery (MCA) occlusion. ICP was repeatedly recorded before and after occlusion of the vessel via a narrow catheter placed in the cisterna magna. MCA occlusion was followed by an increase in ICP, and a pressure peak occurred after 12–24 h in all animals. Subsequently, essentially two patterns of ICP changes were observed. These seemed to be related to the severity of neurological deficits and extension of the infarct area. In the most severely affected animals, raised ICP was noted throughout the 1st week after MCA occlusion; in rats with reversible neurological deficits, ICP returned to normal values after the first peak at 12–24 h. The present investigation shows that prolonged ICP recording is feasible in MCA-occluded rats. The MCA occusion model in rats is well characterized. Thus, ICP registration can be used in conjunction with other methods for evaluating treatment against increased ICP. Dr. Zbigniew Kotwica was a Swedish Institute Research Fellow from September 1, 1987, to August 31, 1988     

48例肺动脉栓塞的诊治分析

目的:探讨肺动脉栓塞的临床特点和诊断方法,提高其诊断水平。方法:回顾分析48例确诊为肺动脉栓塞病例的临床资料。结果:肺动脉栓塞以中老年患者居多,常伴有多种危险因子(如深静脉血栓形成(35.40%)、心血管疾病(40.20%)、恶性肿瘤(12.50%)、外科手术(14.60%)后等)。临床表现不典型,多表现为不明原因的呼吸困难(93.3%)及胸痛(62.5%).部分患者可表现为休克(10.4%)及晕厥(14.6%)。动脉血气分析、血D-二聚体检查、心电图、胸片、超声心动图对肺栓塞的诊断有提示作用;而同位素肺灌注/通气扫描、螺旋CT及肺动脉造影是确诊肺栓塞的较为可靠的诊断方法。结论:肺动脉栓塞是一种常见的肺血管疾病,有较高的病死率。对有症状的高危患者应尽早给予同位素肺灌注/通气扫描和螺旋CT检查以明确诊断。     

PCNL术后肾出血介入止血的临床研究

目的研究PCNL术后肾出血的介入止血方法及效果。方法8例PCNL术后肾出血患者均采用Seldingers法穿刺右侧股动脉，超选择插管至肾动脉或肾段动脉行DSA检查，进一步超选插管至肾动脉出血口，以明胶海绵颗粒（条）进行栓塞，必要时加PVA或弹簧圈等栓塞材料栓塞止血。结果介入方法栓塞治疗PCNL术后肾出血8例，Hb和RBC递增，5～7天痊愈出院。结论介入方法为PCNL术后肾出血止血安全最有效方法。     

A pilot assessment of the FloTrac<Superscript>TM</Superscript> cardiac output monitoring system

Objective To compare measurement of cardiac output (CO) by means of the FloTrac^TM CO monitor with the pulmonary artery catheter (PAC). Design Prospective observational study. Setting Intensive care unit of a tertiary hospital. Patients Six post-operative cardiac surgery patients with existing arterial cannulas and PACs. Interventions Attachment of the FloTrac^TM CO monitor and transducer to an existing arterial cannula. Simultaneous measurements of CO, indexed to body surface area (cardiac index, CI) by the FloTrac^TM CO monitor and by either a bolus thermodilution or continuous CO PAC. Statistical analysis of observations. Measurements and results We performed CO measurements in six patients every 1–4 h after cardiac surgery. Comparison of all measurements showed a limited correlation for CI with the two devices (r ² = 0.1218, bias = 0.21, 95% limits of agreement –0.81, 1.23). CI measurements obtained with the intermittent bolus PAC had better correlation with the FloTrac^TM CI values (r ² = 0.2693, bias = –0.0057, 95% limits of agreement –1.2042, 1.1929) than did those obtained with the continuous CO PAC (r ² = 0.0557, bias = 0.2436, 95% limits of agreement –0.7350, 1.2222). When analysed according to heart rhythm, CI values measured during atrial pacing showed the best correlation (r ² = 0.377, bias = –0.0244, 95% limits of agreement –0.5226, 0.5714). Conclusions CO measurements obtained using the FloTrac^TM CO monitor show a limited correlation with those acquired using the PAC, relatively wide limits of agreement but no clear bias. Further evaluation is required before this device can be recommended for use in the clinical setting.     

Fogarty导管取栓术治疗急性肢体动脉栓塞87例分析

目的 探讨Fogarty导管取栓术治疗急性肢体动脉栓塞的方法和疗效。方法 回顾性分析87例急性肢体动脉栓塞患者（89条患肢）Fogarty导管取栓的疗效。结果 治愈78例，患肢血供保持良好，治愈率87．6％；4例（4．5％）好转；5例截肢（5．6％），其中2例死亡（2．3％）。结论 Fogarty导管取栓术是治疗急性肢体动脉栓塞的有效方法；为防止误诊，对疑有肢体动脉栓塞者应施行超声多普勒检查；一经确诊，尽早手术取栓可减少肢体坏死的危险。     

Radial artery catheterization by surgical exposure in infants

56 radial arteries were cannulated by cutdown technique in 54 critically ill infants (age (mean±SD) 12.2±25.9 days, weight 2710±910 g) for continuous pressure monitoring and repeated blood sampling. 30 patients survived their illness, 24 died. The mean catheterization time in the survivors was 8.1±4.1 in the non-survivors 6.9±5.6 days. Most cannulae were removed electively. 27 of the surviving infants were followed up after 10.5±5.1 months. 25 (86%) vessels were patent, 4 (14%) occluded. No trophic changes of hands or fingers were noted. We conclude that radial artery cannulation by cutdown in infants is a quick and safe technique and is suitable in patients with severe peripheral vasoconstriction.     

多层螺旋CT在肺栓塞诊断中的应用

目的探讨多层螺旋CT在肺栓塞诊断中的临床意义及价值, 分析其CT表现.方法应用多层螺旋CT机对27名肺栓塞病人进行肺动脉增强扫描, 将图像进行多平面(MPR)、曲面(CPR)及斜面(Oblique)重组再处理.结果 27例病人共发现肺动脉栓子146个,其中左及右肺动脉7个,肺叶动脉34个,肺段动脉99个,肺亚段动脉6个.结论多层螺旋CT增强扫描可清楚显示段以上肺动脉血栓栓子,具有方便、快捷、无创、准确的优点,对及时诊断和治疗有着重要的意义,并能有效评估溶栓治疗后的效果.     

肢体动脉急性栓塞或血栓形成的临床处理

目的　探讨四肢动脉急性栓塞或血栓形成的治疗及如何减少并发症的发生。方法　总结 32例动脉栓塞及血栓形成的治疗经验。结果　 6例保守治疗 ,3例行截肢术 ,2 3例行动脉或人工血管切开、Fogarty导管取栓术。术后死亡 3例 ,截肢 5例。结论　尽早的治疗对此病的预后至关重要 ,正确的术中、术后处理明显减少并发症的发生