Coronary Artery Embolism: Two Case Reports and a Review of the Literature

Coronary embolism (CE) is an uncommon and unique cause of acute myocardial infarction. In this report, we review 216 cases of CE including 2 new cases from our institution. The mean patient age was 52.5 years and 62% of the patients were males. Chest pain was the most common presenting symptom followed by dyspnea, and the most commonly affected vessel was the left anterior descending artery. Leading etiologies of the embolus were atrial fibrillation, septic emboli, and iatrogenic causes. Treatment approaches varied with thrombus aspiration being used in 30% of cases. In-hospital mortality rate was 36% and 13% of the cases were complicated by cerebrovascular accident. CE is a unique pathology that leads to acute myocardial infarction. It portends a high mortality rate and requires a high level of suspicion as symptoms may be misleading. Further research is needed in order to improve recognition and management and to lower associated mortality.     

Anatomically contoured large femoral heads can reduce iliopsoas impingement: A cadaver verification study

While use of large heads in total hip arthroplasty (THA) continues to grow, concerns have been raised regarding anterior hip pain resulting from impingement of the prosthetic head against soft-tissues like the iliopsoas. To address these concerns, a new anatomically contoured head (ACH) was developed. In this study cadaver tests were utilized to show that iliopsoas impingement/tenting caused by conventional heads is significantly relieved with the more rounded and reduced distal profile of the ACH. Thus, the ACH implant may be able to decrease the risk of soft-tissue impingement with conventional heads, particularly in the smaller hip.     

SWIM技术治疗后循环大血管闭塞所致急性缺血性卒中的有效性和安全性观察

目的 观察SWIM技术治疗后循环大血管闭塞所致急性缺血性卒中的有效性及安全性。 方法 回顾性分析2017年2月-2018年11月于大连市中心医院采用SWIM技术治疗的后循环大血管闭 塞所致急性缺血性卒中患者的临床资料，评价该技术的疗效和安全性，并分析影响患者预后的因素。 观察指标为术后即刻成功再通（mTICI≥2b）、90 d良好预后（mRS评分≤2分），以及术后24 h任何颅内 出血、90 d全因死亡。 结果 共纳入35例患者，平均年龄66.1±12.1岁，男性26例（74.3%），基线NIHSS评分22（15～34）分。 术后即刻成功再通率为94.3%（33/35），90 d良好预后率为45.7%（16/35），24 h颅内出血率为17.1% （6/35），90 d全因死亡率为37.1%（13/35）。单因素分析显示，基线NIHSS评分较低（P =0.001）、基 线后循环ASPECTS评分较高（P =0.016）、发病至到院时间较短（P =0.039）、发病至再通时间较短 （P =0.047）、血管成功再通率较高（P =0.036）以及饮酒比例较低（P =0.042）与良好预后相关。 结论 使用SWIM技术治疗后循环急性缺血性卒中相对安全、有效。     

急性大血管闭塞性轻型卒中血管内治疗的疗效及安全性观察

目的 观察急性大血管闭塞性轻型卒中患者血管内治疗的疗效及安全性。
方法 回顾性分析2018年1月-2019年5月行血管内治疗的急性大血管闭塞性轻型卒中（NIHSS评分
≤5分）患者的临床资料。观察术后血管成功再通率（mTICI≥2b级）、围手术期并发症、90 d良好预后率
（mRS评分≤2分）等。
结果 共纳入13例患者，平均年龄58.7±14.5岁，男性11例（84.6%）。术后血管成功再通率100%；围
手术期并发症2例，假性动脉瘤1例、无症状性颅内出血1例；90 d良好预后率100%。
结论 急性大血管闭塞性轻型卒中行血管内治疗可能是安全、有效的。     

Clinical outcome of surgical management for patients with renal cell carcinoma involving the inferior vena cava

BACKGROUND: The objective of this study was to evaluate the clinical outcome after surgical management of renal cell carcinoma (RCC) extending to the inferior vena cava (IVC). METHODS: This study included a total of 55 patients (41 men and 14 women; mean age, 59.3 years) with RCC (39 right- and 16 left-sided tumors) involving the IVC, who underwent radical nephrectomy and tumor thrombectomy between 1983 and 2005 at a single institution in Japan. The level of thrombus was classified as follows: level I, infrahepatic; level II, intrahepatic; level III, suprahepatic; and level IV, extending to the atrium. Clinicopathological data from these patients were retrospectively reviewed to identify factors associated with survival. RESULTS: There were 11 and 18 patients who were diagnosed as having lymph node and distant metastases, respectively. Twenty-two patients had tumor thrombus in level I, 20 in level II, 10 in level III, and 3 in level IV. Pathological examinations demonstrated that 34 and 21 patients had clear cell carcinoma and non-clear cell carcinoma, respectively, 42, 9 and 4 were pT3b, pT3c and pT4, respectively, and 6, 35 and 14 were Grades 1, 2 and 3, respectively. Cancer-specific 1-, 3- and 5-year survival rates of these 55 patients were 74.5%, 51.4% and 30.3%, respectively. Among several factors examined, clinical stage (P = 0.047), lymph node metastasis (P = 0.016), histological subtype (P = 0.034) and tumor grade (P < 0.001) were significantly associated with cancer-specific survival by univariate analysis. Furthermore, multivariate analysis demonstrated clinical stage (P = 0.037) and tumor grade (P < 0.001) as independent predictors of cancer-specific survival irrespective of other significant factors identified by univariate analysis. CONCLUSIONS: In patients with RCC involving the IVC, biological aggressiveness characterized by tumor grade rather than tumor extension would have more potential prognostic importance; therefore, more intensive multimodal therapy should be considered in patients with high grade RCC with tumor thrombus extending into the IVC.     

自体动静脉内瘘血栓形成的影响因素

目的：了解动静脉内瘘血栓形成的原因，提出防治措施。方法：81例维持性血液透析患有15例内瘘发生血栓形成。分析病因、性别、年龄、血压、血脂对血栓形成的影响。结果：在内瘘使用的早期(三年内)易发生血栓，内瘘血栓发生率为18．52％。老年、男性、糖尿病、血压低、血脂高的患内瘘易发生血栓．结论：定时监测血管通路，适量使用促红索，缓慢提高血红蛋白，恰当地应用抗凝治疗；减慢透析超滤速度，防止透后低血压；采取阶梯式穿刺法，透析后采取点状压迫，防止力量过大，压迫时问过长和对患及家属进行保护内瘘的宣教均是预防内瘘发生血栓的重要措施。     

肝癌病人血浆和癌组织中血栓调节蛋白的检测

目的　检测肝癌病人血浆和肝癌组织中血栓调节蛋白 (TM )的表达 ,探讨TM与肝癌临床病理特征的关系。方法　用酶联免疫吸附夹心法检测 45例肝癌和 6例肝良性占位病人手术前后的血浆TM水平 ;用免疫组织化学法检测肝癌及肝良性占位组织中的TM蛋白表达水平。结果　术前肝癌组血浆TM水平 ( 10 .2± 5 .7)ng/mL明显高于肝良性占位组 ( 6.1± 2 .2 )ng/mL和正常人对照组 ( 5 .7± 1.0 )ng/mL ,P <0 .0 5 ;术前TM血浆水平肝癌伴门静脉癌栓组 ( 6.9± 4.5 )ng/mL和多发肝癌结节组 ( 8.1± 4.6)ng/mL明显低于无门静脉癌栓组( 11.4± 5 .6)ng/mL和单发肝癌结节组 ( 11.5± 5 .9)ng/mL ,P <0 .0 5 ;40例肝癌病人肝癌切除术前TM水平( 10 .8± 5 .3 )ng/mL与肝癌切除术后 ( 7.6± 4.2 )ng/mL相比差异显著 ,P <0 .0 5。肝良性占位组术前与术后相比差异无显著性 ,P >0 .0 5。肝癌组织中TM蛋白表达阳性的病人术前血浆TM水平明显高于TM表达阴性者 ,P <0 .0 5 ;而术后血浆TM水平两者则无显著性差异 ,P >0 .0 5。结论　肝癌病人血浆中TM水平升高 ,TM水平的高低与门静脉癌栓的形成有关     

Large volume injection and infiltration system

Summary A system which can be used for injection or infiltration of large volumes of fluid is described. This consists of a syringe which fills automatically from a reservoir through an inlet/outlet valve.     

因症就诊检出早期大肠癌的临床及病理学特征

目的探讨在就诊的肛肠病人中如何提高早期大肠癌的检出率。方法在１１家医院推广对肛肠病人的四项检查程序——直肠指检，乙结镜检查，大便隐血试验，和Ｘ线气钡灌肠造影。结果在４８２１例有肛肠症状的病人中，检出大肠癌１８８例，检出率为３．９％，其中１８０例有术后病理诊断。４７／１８０例（２６．１％）属早期癌（ＤｕｋｅｓｓｔａｇｅＡ）。４１／４７例由上述四项检查作出初步诊断。初发症状为：（１）便血（２６例，持续１５．２±９．４周后就诊，肿瘤平均直径２．５８ｃｍ）；（２）大便习惯改变（９例，３３．４±１９．７周，３．３９ｃｍ）；（３）腹痛腹块（１０例，１９．２±１１．２周，５．０ｃｍ）；（４）贫血（２例，１７．２±９．９周，４．７５ｃｍ）。８／１２例的Ａ０和Ａ１期病例属便血组，并多位于直肠。４１／４７例以高、中分化腺癌为主，其中１５例伴有腺瘤癌变。术前曾作活检的２７例中，１２例未检出癌变细胞。结论四项检查对检出早期大肠癌是有效的，便血是提示早期癌最有价值的症状，加强大肠癌防治宣教，采用瘤灶多点或全瘤活检技术，高度重视大肠腺瘤和不典型增生等癌前病变，将有助于提高早期大肠癌的检出率     

Hepatocelular Carcinoma with Tumor Thrombus in Portal Vein:Finding in Ultrasonography,Computed Tomography,Angiography and Chemoembolization

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