早期应用低分子肝素预防腹腔镜脾切除食管胃底静脉断流术后门静脉血栓形成临床研究*

目的 研究早期使用低分子肝素预防腹腔镜脾切除食管胃底静脉断流术（LSED）治疗患者术后门静脉血栓（PVST）发生的作用。方法 我院2014年3月至2015年6月期间收治的112例肝硬化门静脉高压症（PHT）患者,所有患者均行LSED治疗,按患者入院顺序分为两组,每组56例,对照组56例患者采用常规抗凝治疗,另56例患者在上述基础上采用低分子肝素治疗（观察组）。随访两组患者两周,观察两组患者肝功能、门静脉血流状况、凝血功能、PVST以及并发症发生情况。结果 两组患者治疗前后血清TBIL、ALB、INR水平均无显著性差异（P＞0.05）;治疗前两组患者门静脉最大血流速度、平均血流速度和门静脉直径无明显差异（P＞0.05）;治疗后观察组患者门静脉最大血流速度、平均血流速度和门静脉直径分别为（20.83±1.15）cm/s、（15.12±1.19cm/s）和（15.86±3.12）mm,均大于对照组的上述指标【分别为（14.36±0.74）cm/s、（10.28±0.71）cm/s和（14.27±2.96）mm,P＜0.05】;治疗前两组患者凝血功能指标比较无显著差异（P＞0.05）;治疗后,观察组患者血APTT、PT、FIB和TT分别为（25.72±3.64） s、（14.96±2.26）s、（3.51±0.86）g/L和（20.11±3.65）s,均长于对照组的上述指标【分别为（23.37±3.52）s、（13.87±2.14）s、（2.62±0.73）g/L和（18.14±3.23）s,均P＜0.05】;术后观察组和对照组PVST发生率分别为7.14%和42.86%,观察组明显较低（P＜0.05）,观察组和对照组其他并发症发生率无显著相差（P>0.05）。结论 早期应用低分子肝素对预防LSED术后门静脉血栓具有良好的作用,能有效改善凝血功能,同时降低各种并发症,安全性高。     

腔镜下脾切除加选择性贲门周围血管离断术治疗晚期血吸虫病门脉高压合并脾功能亢进效果

目的 目的 探索晚期血吸虫病微创外科处理, 以及在贲门周围血管离断术中更安全精确、 损伤更小的方法。 方法 方法 应用腹腔镜和现代腔镜配套器械开展脾切除, 同时施行胃左静脉的胃支结扎, 以及食管旁静脉垂直进入食管壁的穿支静 脉结扎。结果 结果 14例患者均在处理脾蒂前分离脾动脉主干并夹闭。其中1例中转开腹, 原因为分离脾静脉时破裂出血所 致。无死亡病例。结论 结论 晚期血吸虫病门脉高压脾功能亢进患者经套管针 （Trocar） 腹壁孔将脾脏捣碎夹出, 无需扩大切 口取脾, 保证了真正意义上的微创。     

Chest pain in pacemaker patients,the answer is not always antiplatelets and anticoagulants: A four‐case series

Chest pain in pacemaker patients can be difficult to evaluate due to alterations in QRS and ST segments on the surface ECG. A high prevalence of ischaemic heart disease in this population also serves to influence the differential diagnosis. We highlight four cases, all with simple yet informative imagery, in an attempt to alert clinicians of worrying signs.     

Incidence of Pericardial Effusion in Patients Presenting to the Emergency Department with Unexplained Dyspnea

OBJECTIVE: To evaluate the frequency of pericardial effusion in patients presenting to the emergency department (ED) with unexplained, new onset dyspnea. METHODS: This prospective observational study took place at an urban community hospital ED with a residency program and an annual census of 65,000 visits. Patients presenting between May 1999 and January 2000 with new-onset dyspnea were eligible if they lacked any pulmonary, infectious, hematological, traumatic, psychiatric, cardiovascular, or neuromuscular explanation for their dyspnea after ED evaluation. Patients received a focused echocardiogram by certified emergency physicians. Data were recorded on standardized data sheets and studies were taped for review. Effusions were categorized as small when the fluid stripe measured less than 10 mm. Moderate-sized effusions measured 10 to 15 mm. Large effusions measured more than 15 mm. RESULTS: One hundred three patients were enrolled. Median age was 56 years (IQR 44, 95% CI = 32 to 67). Fourteen patients (13.6%, 95% CI = 8% to 23%) had effusions. Four had large effusions that explained their dyspnea and were admitted to cardiology; two of these effusions were hemorrhagic, and two were viral in origin. Seven patients with small effusions were treated conservatively at home. Three patients had moderate-sized effusions; all were admitted but treated conservatively. CONCLUSIONS: While limited by small numbers, these preliminary data suggest that patients with unexplained dyspnea should be checked for pericardial effusion when bedside ED ultrasound is available.     

Chronic inhibition of cyclooxygenase-2 induces dendritic hypertrophy and limited functional improvement following motor cortex stroke

The cyclooxygenase-2 (COX-2) enzyme is part of the inflammatory pathway and is induced within the brain by a variety of pathological events, including ischemia. Pharmacological agents that inhibit COX-2 have been found to be neuroprotective in a number of injury models, and long-term administration of these drugs has been shown to induce plastic changes in the brain. In the current experiment, we investigated the effectiveness of stimulating cortical plasticity following stroke injury through the administration of the COX-2 inhibitor drug NS398. Furthermore, we determined whether the induced plastic changes improved functional outcome following motor cortex stroke. Chronic drug administration was found to induce dendritic hypertrophy in cells in the parietal cortex, and this anatomical change was associated with the animals making significantly more reach attempts, as well as successful reaches during a skilled reaching task. Additional motor tests however revealed that the treatment did not affect the level of motor recovery, as the animals showed chronic impairments in the Schallert cylinder, and the forepaw inhibition tasks. Short-term administration of the drug, immediately following the stroke did not induce any dendritic changes, nor was it found to improve behavioral performance on any of the motor tasks. Based on these results we conclude that the plastic changes that are induced by long-term COX-2 inhibitor administration provide some benefit to functional outcome following ischemic cortical injury.     

断流术并吻合器横断食管治疗食管曲张静脉出血疗效观察

目的探讨采用断流术并吻合器横断食管治疗门静脉高压症所致食管曲张静脉破裂出血的手术方法和临床效果。方法对48例包括急性出血期急诊手术22例,有出血病史作择期手术的19例和无出血病史作预防性手术的7例,经腹采用吻合器横断食管下段同时进行食管下段及贲门周围血管的选择性离断,观察其近期和远期止血效果。结果术后近期和远期止血效果都比较满意。结论该手术为食管下段横断和对食管下段与贲门周围血管选择性离断的联合应用,术中使用一次性吻合器进行食管下段的横断与吻合,使手术方法简便快捷,可减少手术创伤。     

An unusual cause of a large fibrinous pericardial effusion

The commonest cause of a large fibrinous pericardial effusion in sub-Saharan Africa is tuberculosis. There are, however, limited resources available for making a definitive diagnosis of tuberculous pericarditis. The diagnosis is largely based on clinical criteria. There is a risk of misdiagnosing lesscommon causes of large fibrinous pericardial effusions. We present a patient who had a pericardial angiosarcoma that was initially thought to be a tuberculous pericardial effusion, and discuss the challenges in making a definitive diagnosis of tuberculosis.