重度二尖瓣狭窄合并左心房附壁血栓患者的经皮二尖瓣球囊成形术

对重度二尖瓣狭窄合并左心房附壁血栓的6例患者进行了经皮二尖瓣球囊成形术（PBMV）。结果均获得成功，无一例发生血栓栓塞性并发症，二尖瓣口面积由0．58±0．15cm2扩大到1．56±0．24cm2（P＜0．01），左房平均压由3．37±0．89kPa降至2．08±0．83kPa（P＜0．01），二尖瓣最大跨瓣压差由4．01±1．95kPa降至2．13±0．91kPa（P＜0．01）。心功能由Ⅳ级提高到Ⅲ级4例，Ⅱ级1例，Ⅲ级提高到Ⅱ级1例。我们认为，对已不能耐受外科手术的重度二尖瓣狭窄合并左房心耳部和侧壁的附壁血栓患者，在积极正确的术前准备、掌握好时机和操作熟练的前提下仍可进行PBMV。     

Vascular thrombi and neuronal alterations in human botulism

Summary Pathological study in a case of human botulism showed the presence of minor nerve cell changes and extensive vascular thrombi. The latter occurred chiefly in the central nervous system but occurred in other organs as well. An attempt to put these findings into proper perspective and offer a rational explanation for their frequent occurrence in this syndrome is undertaken. It is suggested that the hemagglutination factor present in botulin may cause changes which play a definite role in the clinical symptomatology. It may account for some observations not explainable by present theories which have limited the action of botulin to the neuromuscular junction.

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Zusammenfassung Die histopathologische Untersuchung eines Falles von Botulismus beim Menschen ergab geringfügige uncharakteristische Nervenzellveränderungen und ausgedehnte rezente Gefäßthromben, die vorzugsweise im ZNS auftraten, aber auch in anderen Parenchymorganen nachweisbar waren. Die Bedeutung dieser Befunde wird erörtert und ihr häufiges Auftreten beim Botulismus zu erklären versucht. Es wird vermutet, daß der im Botulin enthaltene Hämagglutinationsfaktor eine grundlegende Rolle für die klinische Symptomatik und für einige durch die bisher vorliegenden Theorien nicht erklärbare Beobachtungen spielen dürfte.

     

Prolonging the ultrasound signal enhancement from thrombi using targeted microbubbles based on sulfur-hexafluoride-filled gas

RATIONALE AND OBJECTIVES: The objective of this study is to develop and characterize new microbubbles based on lipids and sulfur hexafluoride (SF6) for targeting thrombi as an improved ultrasound contrast agent. MATERIALS AND METHODS: Bioconjugate ligands were inserted into the lipid-coated membranes of SF6 gas microbubbles, and their physicochemical properties were determined. Diagnostic efficacies of SF6-filled microbubbles and the contrast agent SonoVue (Bracco Imaging, Geneve, Switzerland) were compared in dogs. RESULTS: Suspensions of lyophilized powder were reconstituted by injecting saline containing 3.1 x 10(8) SF6 microbubbles/mL with a mean diameter of 4.4 microm. More than 90% of microbubbles had diameters between 1 and 10 microm. After reconstitution, echogenicity and microbubble characteristics were unchanged for 8 hours. Targeted microbubbles increased the echogenicity of thrombi significantly and provided a longer period of optimal signal enhancement compared with nontargeted microbubbles. CONCLUSIONS: Our thrombus-targeting microbubble contrast agent shows high echogenicity and stability and thereby enhances the visualization of intravascular thrombi and prolongs the duration of the diagnostic window.     

豆豉纤溶酶RGDS-载酶脂质体的体内溶栓效果和靶向性评价

研究评价了豆豉纤溶酶(Subtilisin FS33)RGDS-载酶脂质纳米粒的溶栓效果和靶向性,探讨RGDS-脂质体作为载体导向于血栓灶的可能性。不同剂量荧光标记RGDS-载酶脂质体给予血栓模型动物,考察其对机体抗凝血和纤溶功能的影响,以及组织器官的荧光素分布,结果发现,Subtilisin FS33高剂量组注射15 min～2 h,机体的APTT、PT和TT都明显延长(P<0.05,P<0.01),纤溶酶活力明显增高(P<0.05),血浆FDP的含量升高(P<0.05,P<0.01),D-di mer均呈阳性,ELT值降低;低剂量组也有相似趋势(P<0.05);RGDS-载酶脂质体组的大鼠组织切片中脑静脉和肾小球毛细血管中无明显血栓,只有少量红细胞聚积,并且在脑、心脏和肝组织中荧光物的含量显著高于无RGDS-载血清白蛋白脂质体组(空白对照组)。试验表明静注RGDS-载酶脂质体可明显增强机体的抗凝和纤溶能力,RGDS-载酶脂质体具有一定的血栓靶向性。     

Intravascular papillary endothelial hyperplasia of the extremities: MR imaging findings with pathologic correlation

We report the MRI findings of three cases of intravascular papillary endothelial hyperplasia (IPEH) of the extremities with correlation of the pathologic findings. The IPEH is a non-neoplastic reactive lesion within the vessels and is commonly associated with thrombi. Signal intensity of the IPEH is complex due to the thrombi and the PEH itself. The thrombi are characterized by a slightly hyperintense signal on T1- and T2-weighted images compared with that of muscle when it comes at the medium stage of hemorrhage. Papillary endothelial hyperplastic tissue appears either as iso- or hyperintense to the muscle on T2- and T1-weighted images and shows variable enhancement on Gd-DTPA-enhanced images.     

TEE screening in atrial flutter: a single-centre experience with retrospective validation of a new risk score for the presence of atrial thrombi

Transesophageal echocardiography (TEE) has been proposed as a screening tool to exclude the presence of atrial thrombi and left atrial spontaneous echocontrast before cardioverting persistent atrial flutter (AFl) and atrial fibrillation (AF). However in pure AFl a very low prevalence of atrial thrombi has been observed by many investigators: a confirmation of this finding would make TEE screening redundant.We review our database of patients with AFl who underwent TEE screening before cardioversion in the last 5 years. A new risk score for the presence of left atrial thrombus (AFLAT score) is here proposed, as a potential tool to avoid unnecessary TEE exams.Out of the 106 patients examined, in fourteen left atrial thrombi were diagnosed (13%). Only two cases belonged to the pure AFl subgroup (prevalence = 3%), while twelve cases were detected in the subgroup of AFl patients with previous AF episodes (prevalence = 32%, p < 0.001).All of the fourteen patients with a positive TEE for thrombus were identified by a AFLAT score > 2. The validation of this index in a larger and prospective setting would lead to a 85% reduction in unnecessary TEE exams in patients with pure AFl undergoing cardioversion.     

磷脂酰肌醇3激酶通过mDial参与调控凝血酶诱导的血小板聚集

目的 探讨mDial(mammalian diaphanous 1)在人血小板中的表达和血小板聚集过程中的作用以及磷脂酰肌醇3激酶(PI3K)对该过程的调控作用.方法 采用血小板聚集仪检测PI3K抑制剂和抗mDial抗体导入后对人血小板聚集率的影响;Western blot法检测mDial在血小板静止及活化过程中的表达及其与肌动蛋白细胞骨架的关系.结果 mDial在血小板静止、凝血酶诱导的铺展或聚集血小板内表达水平没有明显差异;凝血酶诱导血小板聚集过程中,mDial从Triton-X100可溶性(胞质)部分向Triton-X100不可溶性(细胞骨架)部分转位;抗mDial抗体导入血小板后能够抑制凝血酶诱导的血小板聚集;PI3K抑制剂渥曼青霉素及Ly294002能够抑制血小板聚集,抑制mDial从Triton-X100可溶性部分向Triton-X100不可溶性部分的转位.结论 PI3K通过mDial参与调控凝血酶诱导的血小板聚集过程中肌动蛋白细胞骨架的重构.     

冠心病病人球结膜微血栓与病情关系的观察

作者对１８０例冠心病病人球结膜微循环进行了观察，发现有微血栓者占２３．９％。分阶段地将有微血栓、无微血栓的冠心病病人及正常人三者进行对照，并对有微血栓的冠心病病人作了肝素或丹参治疗前后的对比观察。     

Prise en charge et pronostic des embolies pulmonaires associées à des thrombi intracavitaires droits : à propos d’une série prospective au centre Hospitalier Universitaire Yalgado Ouédraogo

Objective

To describe the management and evolution of high risk of death pulmonary embolism associated with right heart thrombi.