心包炎患者心包切除术后的病因分析

目的 :探讨心包炎心包切除术后的病因诊断 ,以提高心包炎的临床诊断水平。方法 :回顾性分析 5 2例行心包切除术并有病理检查结果的心包炎临床与病理资料。结果 :结核性 14例 ( 2 6 .9%) ,癌性 4例 ( 7.7%) ,非特异性改变 34例 ,其中 2例为创伤性、1例为放射性 ,其他 31例 ( 5 9.7%)原因不能确定。与非特异性组比较 ,结核性心包炎患者的病程较短 (P <0 .0 1) ,有发热、急性心包炎、中至大量心包积液和心脏压塞病史者较多 (P <0 .0 5～0 .0 1) ;4例癌性心包炎均表现为顽固性渗液性心包炎。结论 :缩窄性心包炎多数病例病因不明 ,在已知的病因中 ,以结核多见 ;顽固性心包渗液多见于恶性肿瘤。     

Modified Ross procedure with stentless bioprosthesis and pericardial xenograft for the right ventricular outflow tract

A 31-year-old man with severe aortic regurgitation due to a defective bicuspid valve underwent surgery using modified Ross procedure. The right ventricular outflow tract (RVOT) was reconstructed with a 25 mm stentless xenograft valve sutured with a rolled equine pericardium. Oozy bleeding from the RVOT was controlled with an autologous pericardial patch and fibrin glue. Postoperative echocardiography showed no aortic regurgitation. No blood transfusion was required.     

完全腹腔镜巨脾联合贲门周围血管离断术治疗门静脉高压症

目的总结完全腹腔镜下巨脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症的手术技巧和临床应用价值。方法回顾性总结了2005年3月—2006年9月间,一个治疗小组对23例肝硬化门静脉高压致食管下端静脉曲张患者应用超声刀行完全腹腔镜下巨脾切除联合贲门周围血管离断术治疗的临床资料。结果23例中有20例在处理脾蒂前结扎脾动脉;中转开腹3例（13．0％）,其中脾叶静脉破裂出血2例,左膈静脉破裂出血1例;20例顺利完成手术,其中18例应用二级脾蒂离断法处理脾蒂一逐支分离脾叶动静脉,边分离边用血管夹夹闭或丝线结扎离断血管,2例应用腔内直线型切割钉合器（Endo—GIA）集束离断二级脾蒂血管。手术时间180—350min,平均235mill。术中失血200—1600ml,平均520ml。术后经输血浆、利尿、预防抗炎治疗。术后发生胸腔积液3例,左膈下脓肿1例,B超引导穿刺治愈,轻度腹水2例。无死亡病例。术后住院时间6—17d,平均8．5d。术后平均随访时间9个月,再出血率0％。结论娴熟的互相配合的腹腔镜技术、术中应用超声刀和预先结扎脾动脉,应用二级脾蒂离断法处理脾蒂是完全腹腔镜下巨脾切除联合贲门周围血管离断术手术成功的关键技术要素。手术仍具有微创的优势。【关键词】腹腔镜脾切除术;门奇断流术;高血压,门静脉;食管和胃静脉曲张     

癌性心包积液的超声心动图表现

本文报道4例经病理证实为癌性心包积液所致的“心脏摇摆综合征”的超声心动图表现,并对此现象产生的机理进行了讨论。本组病例观察表明,大量心包积液出现心脏摇摆综合征,特别是在成年人出现心脏机械性交替合并电交替的典型“心脏摇摆综合征”时,应高度怀疑癌性心包积液的可能。     

80例心包积液患者临床病因及误诊分析

目的:分析心包积液患者的病因及误诊原因。方法:收集彭州市人民医院和成都市第五人民医院1997~2006年心包积液患者80例,对其临床资料进行回顾分析。结果:心包积液的常见原因依次为肿瘤性(25·0%)、结核性(18·8%)、非特异性(13·7%)、心力衰竭性(12·5%)、尿毒症性(10·0%),其他原因(20·0%)。其中有6例误诊。结论:结核性心包积液比例明显下降,而肿瘤性心包积液所占比例明显上升,已成为心包积液的首要原因。误诊的主要原因是将肿瘤性心包积液诊断为其他性质的心包积液。     

Bronchogenic cyst with multiple complications

Bronchogenic cysts are a rare type of mediastinal mass thought to arise from abnormal budding of the embryologic foregut. This paper presents a rare case of a 32-year-old male who developed multiple serious complications from a bronchial cyst. This rare presentation is discussed and the role of CT and MR imaging in making the diagnosis is highlighted.     

Intrapericardial administration of basic fibroblast growth factor: myocardial and tissue distribution and comparison with intracoronary and intravenous administration.

Growth factor-induced angiogenesis is being investigated in ischemic heart disease. Intracoronary and intravenous delivery are the most practical, but are limited by low myocardial uptake and significant systemic recirculation. The pericardial space may act as a drug delivery reservoir with increased myocardial uptake and reduced systemic toxicities. This study was designed to investigate the myocardial and tissue deposition and retention of basic fibroblast growth factor (FGF-2) after intrapericardial administration in normal and chronically ischemic animals. Twelve Yorkshire pigs were used for the study [six normal and six animals with chronic myocardial ischemia (ameroid constrictor on LCx)] with bolus intrapericardial administration of (125)I-FGF-2 (25 micro Ci) with 30 micro g of cold FGF-2 and 3 mg of heparin. Tissue and myocardial distribution was determined at 1 and 24 hr by measuring (125)I-bFGF-specific activity. In addition, regional myocardial deposition was determined using (125)I-bFGF activity and organ level autoradiography. The heart (pericardium and myocardium) accounted for the majority of (125)I-bFGF activity in ischemic animals (30.9% at 1 hr and 23.9% at 24 hr). Left anterior descending artery territory activity/gm of tissue for nonischemic and ischemic animals was 0.01% and 0.01% at 1 hr and 0.0009% and 0.12% at 24 hr, respectively. LCx territory activity for nonischemic and ischemic animals was 0.006% and 0.008% at 1 hr and 0.03% and 0.05% at 24 hr, respectively. Endocardial activity was low at all time points. Liver uptake was 0.47% (nonischemic) and 0.34% (ischemic) at 1 hr and 0.23% (nonischemic) and 0.54% (ischemic) at 24 hr. Intrapericardial delivery of FGF-2 provides markedly higher myocardial deposition and retention and lower systemic recirculation than intracoronary or intravenous delivery at the expense of poor subendocardial penetration. This limitation, however, did not affect its efficacy.     

The role of infarction-associated pericarditis on the occurrence of atrial fibrillation

Aims Transient atrial fibrillation is a relatively common arrhythmiain the early phase of acute Q-wave myocardial infarction. However,the role of infarction-associated pericarditis on the genesisof atrial fibrillation is controversial. This study was designedto examine the relative importance of infarction-associatedpericarditis among other clinical variables on the genesis oftransient atrial fibrillation in patients with acute myocardialinfarction. Methods and results Three hundred and ninety-eight patients with acute Q-wave myocardialinfarction were examined carefully by means of auscultation,ECG, two-dimensional echocardiography and haemodynamic measurements.The diagnosis of pericarditis was made on the basis of pericardialrub detected during the first 3 days after admission. At least0·5mm of PQ-segment depression from a TP segment lastingmore than 24h in both limb and precordial leads was considereddiagnostic of PQ-segment depression. Atrial fibrillation waspresent in 76 patients (19%). Sixteen (42%) of 38 patients withPQ-segment depression had atrial fibrillation, whereas 23 (30%)of 77 patients with pericardial rub had atrial fibrillation.Based on ten clinical variables, multivariate analysis was performedto determine the important variables related to the occurrenceof atrial fibrillation. PQ-segment depression (chi-square=4·10,P<0·05) was selected with age (chi-square=10·52,P<0·005), the number of left ventricular segmentswith advanced asynergy (chi-square=7·73, P<0·01)and pericardial effusion (chi-square=7·95, P<0·005)as important factors related to atrial fibrillation. Patientswith PQ-segment depression had a significantly higher pulmonarycapillary wedge pressure than those without it. Conclusion Among patients with infarction-associated pericarditis, thosewith PQ-segment depression represent atrial involvement associatedwith extensive myocardial damage and hence, PQ-segment depressionis one of the clinical signs related to the occurrence of atrialfibrillation in acute Q-wave myocardial infarction.