【摘要】 目的 總結甲型H1N1流感病毒性肺炎患者的胸部X線和CT表現特征。 方法 回顧分析2009年3月-11月3例經臨床表現及病原學檢查證實的甲型H1N1流感病毒性肺炎的胸部X線、CT表現。 結果 肺部病灶多呈散在小片狀高密度影，邊緣模糊，鄰近胸膜；病變最常累及肺基底段；病灶多有少量胸腔積液；病灶有擴散迅速，合理用藥后消失較快的特點；病灶吸收落后于臨床表現。 結論 甲型H1N1流感病毒性肺炎的X線、CT表現具有一定的特點，總結并掌握這些特點，有利于早期診斷。其確診有賴于實驗室檢查和流行病學調查。【Abstract】Objective To explore the chest X-ray, CT manifestations of pneumonia of patients with influenza virus A/H1N1 infection. Methods The pulmonary X-ray and CT findings of 3 patients who were confirmed by laboratory results and epidemiology with infection of influenza virus A/H1N1 were retrospectively analyzed between March 2009 to November 2009. Results Both sides of the lung field showed many small cloudy infiltration in chest X-ray and CT film. The lesions of the lung were mostly near the pleural. They were often found in basal segment. Pleural effusion may be observed. Radiology dynamic changes showed the diffusion of the lesions of the lung was quick in a short time, and scattered and disappeared quickly after rational use of drugs. The lesions vanished later than clinical disappearance. The lesions of the lung may appear fibrosis at the period of the end. Conclusion Some radiographic characteristics exist in the pneumonia of patients with influenza virus A/H1N1 infection. It will be helpful for early diagnosis when getting familiar with its X-ray and CT manifestations, but the final diagnosis depends on the laboratory results and epidemiological history.
In recent years, the transcatheter interventional therapy of valvular disease has been developed rapidly, and new therapeutic devices are emerging, which has become the first-line treatment in parallel with surgery. Although the interventional therapy of valve disease in China started relatively late, the development speed is relatively fast, and many remarkable achievements has been accomplished. This article will introduce the application of transcatheter intervention in valvular diseases in China, including aortic valve disease, mitral valve disease, pulmonary valve disease and tricuspid valve disease.
目的 觀察非甾體抗炎藥依托芬那酯凝膠聯合中樞性肌松藥替扎尼定對治療有潛在胃腸道風險的急性痙攣性頸肩腰痛的療效和安全性。 方法 2012年3月－5月共診斷急性痙攣性頸肩痛及腰痛患者375例，依據排除標準排除33例，根據分組標準將有潛在胃腸道疾病風險者設為試驗組（A組，n=63），明確無胃腸道疾病史者按照年齡、性別和疼痛部位與試驗組進行配伍設為陽性對照組（B組，n=63）和安慰劑對照組（C組，n=63），未分組144例不納入統計。試驗組服用替扎尼定2 mg，2次/d，同時外用依托芬那酯凝膠5～10 cm均勻涂抹患處，3次/d；對照組服用替扎尼定2 mg，2次/d，同時口服塞來昔布0.2 g，2次/d；安慰劑對照組服用替扎尼定2 mg，2次/d，同時安慰劑1粒，2次/d。觀察藥物療效和不良反應。 結果 A組隨訪57例，平均起效時間為（2.17 ± 0.99） d，總有效44例（77.2%），胃腸道不良反應2例（3.5%）；B組隨訪54例，平均起效時間為（1.78 ± 0.96） d，總有效45例（83.3%），胃腸道不良反應發生3例（5.5%）；C組隨訪55例，平均起效時間（4.10 ± 1.63） d，總有效35例（63.6%），胃腸道不良反應發生2例（3.6%）。 結論 依托芬那酯凝膠和口服非甾體抗炎藥療效和起效時間相當，胃腸道耐受性較好，聯合用藥效果優于單獨使用肌松藥。對于有潛在胃腸道風險的痙攣性頸肩腰背痛患者可選擇外用非甾體抗炎藥聯合中樞性肌松藥的治療方案，以獲得更好的療效以及較高耐受性。
Transcatheter aortic valve replacement (TAVR) developed rapidly since firstly introduced to clinical practice in 2002. In 2015, Experts Consensus for Transeatheter Aortic Valve Replacement (abbreviated as the Consensus) helped TAVR develop normatively and safely in China. This article interpreted the Consensus in combination of new evolutions of TAVR field: first, the indications of TAVR expand from inoperative and high risk patients to the intermediate risk patients; second, although the Consensus recommended pre-dilation with balloon of modest size, the necessity of pre-dilation is under debate; third, the Consensus pointed out main complications of TAVR, and the main strategies to avoid complications are careful pre-procedural analysis and development of new device; fourth, our experts had made outstanding contribution to TAVR in the treatment of patients with bicuspid aortic valve, which still has many problems to be solved urgently.
To investigate the change of bacterial load appl ied with iodophors and rivanol of diabetic foot ulcers (DFUs), furthermore to evaluate the effect of both in removing superficial microbes of DFUs. Methods From March 2006 to March 2007, 30 patients were randomly divided into control group (group A, n=10), iodophor group (group B, n=10) and rivanol group (group C, n=10). There were 18 males and 12 females with an average age of 59.8 years (range 46-78 years). The wound size ranged from 3 cm × 2 cm to 15 cm × 10 cm. The disease course was 6 weeks to 6 months (mean 2.1months). Each wound was debrided and irrigated before process, then drug was compressed on the wound for 5 minutes, and irrigated again. The samples gained for three times, before, immediately and 24 hours after the process. Each sample was diluted before cultivation, the bacteria of wound were counted and compared among 3 groups. Results The cultures of specimens showed that the load decreased in every group, each cultured colony of specimen grew well, and there were no significant differences between 3 groups immediately after procedure (P gt; 0.05). There were significant differences between group B and groups A, C (P lt; 0.05), but there were no significant difference between group A and group C 24 hours after treatment (P gt; 0.05). Conclusion Both iodophors and rivanol could remove the bacteria on the surface of wound. Topical germicide could reduced bacterial load in the wound of diabetic foot, the role of steril izing and bacteriostasis of iodophors were better than that of rivanol.
As the indications for transcatheter aortic valve replacement (TAVR) expand to low-risk young patients, the number of patients undergoing percutaneous coronary intervention (PCI) after one or more TAVR may increase. The coronary access for PCI after TAVR has become a very practical and severe problem. Coronary re-intervention poses technical difficulties, and compared to balloon expandable valve, the use of self-expanding valve is more challenging for the coronary access for PCI after TAVR. This article discusses the selection of appropriate valves before TAVR, the implementation of intraoperative commissural alignment technology, and the techniques for mastering the coronary access for PCI after TAVR, in order to improve the success rate of the coronary access for PCI after TAVR.
Objective To investigate the clinical features of non-gastrointestinal mucosa-associated lymphoid tissue ( MALT) lymphoma.Methods Forty-eight pathologically proved cases of nongastrointestinal MALT lymphoma, admitted into Peking Union Medical College Hospital fromJanuary 2000 to July 2011, were retrospectively analyzed.Results There were 32 females and 16 males. The median age at diagnosis was 55. 4 years old ( range, 21-76 years) . The most commonly affected sites were lung, salivary glands, thyroid and ocular adnexa. In5 cases, the lymphoma presented at multiple mucosal sites. 27 patients were asymptomatic while 13 had non-specific symptoms. Blood test showed mild or moderate anemia in 8 cases, elevated erythrocyte sedimentation rate in 19 cases, and elevated lactate dehydrogenase in 6 patients.Imaging examinations revealed enlarged lymph nodes in 20 patients. 6 patients had a history of Sjoren’s syndrome, in whom3 cases were salivary gland diseases. In the patients with lung involvement, pathological diagnosis was obtained by bronchial biopsies in 3 cases, by CT-guided percutaneous lung biopsies in 11 cases, and by surgical biopsies in 9 cases. While in the patients without lung involvement, pathological diagnosis was obtained all by surgical biopsies. Of the 23 patients with lung involvement, 1 remain untreated,while 22 received various combinations of treatment ( surgery alone in 3 patients, surgery plus chemotherapy in 6 patients, and chemotherapy alone in 13 patients) . Of the 25 patients without lung involvement, 11 patients received surgery alone, 10 patients received surgery plus chemotherapy, 3 patients received chemotherapy alone, and 1 patient received surgery plus chemotherapy and radiotherapy. 46 patients remained alive during the median follow-up of 46. 7 months ( range, 4-133 months) . While 1 patient with lung involvement died from unknown causes, another 1 patient with lung involvement died from lung infection. Conclusions Non-gastrointestinal MALT lymphoma tends to occur in old-aged females, and commonly occurs in lung, salivary gland and thyroid sites. Most patients are asymptomatic or have only nonspecific symptoms. CT-guided percutaneous lung biopsies and surgical biopsies are helpful to the diagnosis.Prognosis for this lymphoma tends to be indolent.
With the development of transcatheter aortic valve replacement, it has become the first-line treatment for elderly patients with aortic valve stenosis. A case of transcatheter aortic valve replacement in a patient at high risk of coronary artery occlusion was reported. The use of intravascular ultrasound to observe the spatial relationship between the coronary ostia and the valve was the characteristic of this case. This patient was an elderly male who was assessed as a high risk of acute coronary artery occlusion before transcatheter aortic valve replacement. After fully evaluation of the patient’s surgical risks\benefits, the strategy was formulated. Percutaneous coronary intervention was the first step. At the same time, intravascular ultrasound was used to observe the spatial relationship between the coronary ostia and the valve, and balloon was embedded for coronary protection. The procedure went smoothly.
The short-term mortality of patients with severe aortic stenosis is high, which presents a great challenge to clinical treatment. With the development of transcatheter aortic valve replacement (TAVR), emergent TAVR brings hope for the treatment of these patients. We present here a case of emergent TAVR procedure. The patient was an elderly male who had previously undergone surgical mitral valve replacement. After fully assessing the risk/benefit of TAVR procedure, emergent TAVR was performed for the patient. The patient was in good condition at two-month follow-up. Emergent TAVR is a good option for critical high-risk patients with severe aortic stenosis.
Objective To evaluate the coronary artery ostium obstruction caused by the commissure of transcatheter heart valve (THV) with the markers on THV under X-ray, which was identified by observing the position relationship between the commissure of THV and the coronary artery ostium from analyzing aortic root computed tomographic angiography (CTA) images after transcatheter aortic valve replacement (TAVR). Methods A retrospective analysis was performed on 25 patients undergoing TAVR who were checked with electrocardiographically gated CTA for the aortic root after the TAVR procedure between January 2020 and December 2021 in General Hospital of Northern Theater Command. The images of THV with the lowest position of non-coronary sinus and the right anterior oblique and caudal in most cases were observed when the THVs were deployed. The position relationships of the three markers on the THV after valve release were recorded, which were divided into three conditions, namely the three markers being averagely distributed, the middle marker being close to left, and the middle marker being close to right. Postoperative CTA images of the patients were analyzed. The angle between the commissure of THV and the coronary artery ostium was measured, and the angles in each group were presented as medium (lower quartile, upper quartile). Results A total of 17 patients were finally included. The angles between the commissure of THV and the left coronary artery ostium were 19.0 (16.0, 31.0)°, 36.0 (15.0, 44.0)°, and 3.0 (3.0, 5.0)° in the markers averagely distributed group (n=7), the middle marker close to left group (n=6), and the middle marker close to right group (n=4), respectively, which were significantly different (P=0.033). The angles between the commissure of THV and the right coronary artery ostium were 43.0 (25.0, 51.0)°, 47.0 (41.0, 57.0)°, and 13.0 (7.5, 21.0)° in the markers averagely distributed group, the middle marker close to left group, and the middle marker close to right group, respectively, which were significantly different (P=0.017). There was significant difference in the obstruction degrees of left coronary artery ostium by the commissure of THV (P=0.008), and no significant difference in the obstruction degrees of right coronary artery ostium (P=0.062). When the middle marker was close to right, there was no more than moderately obstruction on the right coronary artery ostium and no any obstruction on the left coronary artery ostium. When the middle marker was close to left, the obstruction rate of the left coronary artery ostium with more than moderate degree was 4/6 (66.7%) and it was 6/6 (100.0%) for the right coronary artery ostium. Conclusions The degree of coronary artery ostium obstruction by the commissure of THV can be accurately evaluated by using markers on THV. Among them, when the middle marker is close to right, the commissures of THV are least likely to block the coronary artery ostium.