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.     

Local fibrinolysis for superior mesenteric artery thromboembolism

A 66-year-old man with atrial fibrillation was referred soon after developing left lower limb and abdominal pain with rectal bleeding. An immediate flush aortogram showed embolic occlusion of the left distal superficial femoral artery and superior mesenteric artery (SMA), 3 cm from its ostium. Recombinant tissue plasminogen activitor (rtPA) 40 mg was selectively in stilled in the SMA in two boluses. Abdominal symptoms resolved within 48 h, and complete recanalization of the SMA was shown on angiography. Exploratory laparotomy after 72 h showed a normal small bowel and right colon, and was completed by femoropopliteal embolectomy. Six months later, the patient remained asymptomatic.     

三维适形放射治疗门静脉癌栓23例

目的探讨三维适形放射治疗门脉癌栓的近期疗效.资料与方法 23例均为肝癌介入治疗后出现门静脉癌栓,其中原发性肝癌8例,转移性肝癌15例,所有病人均在介入治疗2～4次后出现门静脉癌栓.采用三维适形照射的方法,每例均设定4～6个非共面野,单次照射剂量3～7Gy,6～15次,每日或隔日照射,总剂量42～48 Gy.结果总有效率3个月为82.6%,6个月为95.7%,Kaplan-Meier分析法,1、2、3年生存率分别为82.6%、43.5%和26.1%,中位生存期14个月.Cox回归分析提示Child-Pugh肝功能分级和单次照射剂量与预后有关.结论三维适形放射治疗肝癌介入后门静脉癌栓是一种方法简单、病人易于接受、近期疗效显著的可行性方法,值得临床推广.     

原发性肝癌介入治疗中化疗栓塞模式的探索

为探讨空气作为栓塞剂在原发性肝癌介入中的应用并作出评价，选择１３例不能切除的原发性肝癌经肝动脉静灌注化疗后用空气２０～３０ｍｌ栓塞，２～３周一次，反复治疗２～４次，疗程末用碘油阿霉素乳剂作最后栓塞，治疗中观察血象，肝功能，ＡＦＰ和肿瘤大小的变化，并作长期随访。结果：治疗后肿瘤缩小５０％以上者３例，不足５０％者９例，变化不明显１例，随访结果６例生存不足６月，３例生存１０月，２例１２月，另２例生存超过     

Hydrogels in endovascular embolization. II. Clinical use of spherical particles

In this study we report the results of clinical experiments, obtained with spherical particles made from poly(2-hydroxyethyl methacrylate) used in the embolization of arteriovenous anastomoses, in the suppression of pulmonary haemorrhage and haemoptysis and in the occlusion of some other arteries. So far we have used these particles in the treatment of 187 patients. It must be stressed that the advantage of spherical particles consists in the simplicity of their introduction into the blood vessel through a catheter, while in the blood vessel itself the particle swells in blood still more, when compared with the particle size in saline. This results in an immediate and permanent haemostatic effect. No revascularization occurs.     

Real-time identification and archiving of micro-embolic Doppler signals using a knowledge-based DSP system

Identification of micro-emboli in the cerebral circulation using transcranial Doppler ultrasound provides valuable clinical information, but, currently, embolic signal detection and analysis are significantly limited because they mainly rely on costly off-line analysis by human experts. In this study, a reliable, high-resolution, real-time automated system for the detection and archiving of embolic signals was designed and implemented using expert system theory and modern DSP technology. Preliminary tests were conducted to evaluate the functions and the performance of the system using data from ten carotid endarterectomy patients and two normal volunteers. Using the widely accepted 7 dB threshold for human reliability and a human expert, majority-decision gold standard, the real-time system reached sensitivity and specificity of 93.6% and 99.3%, respectively, which were close to the results obtained by three human experts under ideal laboratory conditions (90.1% and 99.8%, 98.4% and 99.9%, 98.9 and 99.9%). The new system has the potential to be used either as a bedside monitoring and signal acquisition device, or as a laboratory investigation tool.     

CTCs与结直肠癌病理特征及术后复发的关系研究

目的通过检测结直肠癌患者术前外周血循环肿瘤细胞(CTCs),探讨结直肠癌患者术前CTCs检出水平与临床病理特征及预后的关系。方法收集2017年3月1日-2019年6月30日的40例结直肠癌患者及36例良性疾病患者的外周血,采用FISH法检测CTCs,比较两组患者的CTCs检出水平、癌胚抗原(carcinoembryonic antigen,CEA)、TNM分期(T是原发灶,N是淋巴结,M是远处转移)、肿瘤分化程度、脉管癌栓之间的关系,并进行统计学分析。结果 (1)结直肠癌组中CTCs阳性率为62.5%,良性肿瘤对照组中阳性率为5.6%,差异具有统计学意义(P <0.05)。(2)结直肠癌患者组术前CTCs阳性率高于CEA(P <0.05)。(3)CTCs术前阴性组患者术后复发的风险低于CTCs阳性组(P <0.05)。(4)术前CTCs阳性患者的术后病理结果中,脉管癌栓阳性率高于CTCs阴性组(P <0.05)。结论 CTCs在恶性肿瘤中表达比良性肿瘤高,对恶性肿瘤的诊断有较大的指导意义。CTCs敏感性高于CEA,两者结合可提高结直肠癌的检出率。CTCs阳性的结直肠癌患者出现脉管癌栓率较高,复发危险度较高,可作为结直肠癌预后的重要指标。     

ADA，CEA、CA对癌性与结核性胸水的鉴别

目的：探讨腺苷氨酶（adnosine deaminase,ADA),癌胚抗原（carcinoembryonic antigen,CEA),糖类抗原（carbohydrate antigen,CA)对癌性与结核性胸水的鉴别意义,方法：对3年来确诊的结核性胸水53例,癌性胸液43例患者的胸水标本进行检测,结果：在结核性胸液中,ADA均值显著高于其在癌性胸水中的均值（P＜0．01）,而且检测的敏感性,特异性和准确性较其他指标均高（P＜0．01）,在癌性胸液中,CEA,CA50,CA125,CA199,CA211的均值较它们在结核性胸液中的均值显著升高（P＜0．01,P＜0．05）,结论：在癌性与结核性胸水的鉴别中,对ADA和CA211的联合检测,在胸水性质的鉴别中比其它指标更有意义。     

When To Hospitalize The Emphysema Patient

With emphysema now ranking second among causes of disability in men past 40, Dr. Haas believes that careful reappraisal of the criteria for hospitalization in this disease is indicated. Critical to this reappraisal, he maintains, is recognition that many patients now “written oil'” as hopeless cripples may be returned to “the dignity of economic and social independence.”     

Obstetric emergencies

For more than 60 years the Confidential Enquiry into Maternal Deaths triennial reports and later reports from Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) have helped build a picture of maternity care within the UK highlighting not only our successes but failures in caring for women within the puerperal period. Despite most obstetric emergencies being well described and having clear management strategies and guidance, there continues to be substandard management with poor outcomes recorded. This article describes some common obstetric emergencies with which the anaesthetist will become involved. It emphasizes management related to some deficiencies identified in the MBRRACE-UK report as well as highlighting a multidisciplinary approach throughout. Good communication between team members is paramount in all aspects of medical care but this approach should be fostered routinely to ensure that rapid and appropriate decisions are made in a safe and timely manner.