Myelopathy is a common etiology of acute bilateral limb weakness. While painless acute aortic dissection(AAD)is the most common catastrophic event that can mimic myelopathic manifestations of acute bilateral limb weak...Myelopathy is a common etiology of acute bilateral limb weakness. While painless acute aortic dissection(AAD)is the most common catastrophic event that can mimic myelopathic manifestations of acute bilateral limb weakness, it is often easily ignoredWe describe a case of painless AAD in a 70-year-old man with a history of hypertension manifesting as acute myelopathy(bilateral limb weakness and loss of all types of sensation)with increased levels of serum myoglobin and D-dimer.Magnetic resonance imaging of the spinal cord revealed a normal thoracic and lumbar spinal cord but a dissection of the thoracic aorta. Computed tomography angiography of the chest and abdominal aorta showed a Stanford type B dissection extending throughout the thoracic aorta and into the abdominal aorta hypomere.The patient died because of a sudden drop in blood pressure during transfer to vascular surgery.The clinical presentation of painless AAD mimics myelopathies.Aortic dissection should be considered in patients presenting with acute bilateral limb weakness.Physical examination of the skin temperature,dorsalis pedis artery,serum D-dimer,and myocardial markers can provide diagnostic clues.展开更多
BACKGROUND： Development of new coronary thrombolytic agents is hot in the market. A new drug, mutated recombinant tissue-type plasminogen activator （rtPAm）, is the product of mutation of tPA by changing binding loc...BACKGROUND： Development of new coronary thrombolytic agents is hot in the market. A new drug, mutated recombinant tissue-type plasminogen activator （rtPAm）, is the product of mutation of tPA by changing binding loci with plasminogen activator inhibitor （PAl）-1 to reduce the degradation. In vitro test has demonstrated that the activity of rtPAm is much higher than rtPA in the absence of PAl. The present study is to observe the efficacy of mutated recombinant tissue-type plasminogen activator （rtPAm） in coronary thrombolytic therapy.METHODS： A total of 30 adult beagles were equally divided into 5 groups after thrombi： vehicle group, urokinase group, rtPAm low-dose group, rtPAm medium-dose group, and rtPAm high-dose group. Thrombolytic effect and myocardial infarction were observed after thrombolytic therapy.RESULTS： In the urokinase group, time to reperfusion was （15.8±3.8） minutes. TIMI 2 flow was demonstrated in 4 beagles, TIMI 3 flow in 2, and re-occlusion in 4 after 90 minutes respectively. In the low- dose rtPAm group, time to reperfusion was （15±4.5） minutes; TIMI 2 flow was demonstrated in 2 beagles, TIMI 3 flow in 4, and re-occlusion in 2 after 90 minutes. In the high-dose rtPAm group, time to reperfusion was （7.5±2.6） minutes. None of the beagles showed re-occlusion after 90 minutes. The infarction areas were （2.1±0.9）% in the medium-dose rtPAm group and （0.7±0.4）% in the high-dose rtPAm group, which decreased significantly than those in the low-dose rtPAm group. The aggregation rate in the medium-dose and high-dose rtPAm groups decreased significantly than that in the urokinase group.CONCLUSION： rtPAm may serve as a thrombolytic agent with platelet-targeted fibrinolysis and antiplatelet aggregation activities.展开更多
文摘Myelopathy is a common etiology of acute bilateral limb weakness. While painless acute aortic dissection(AAD)is the most common catastrophic event that can mimic myelopathic manifestations of acute bilateral limb weakness, it is often easily ignoredWe describe a case of painless AAD in a 70-year-old man with a history of hypertension manifesting as acute myelopathy(bilateral limb weakness and loss of all types of sensation)with increased levels of serum myoglobin and D-dimer.Magnetic resonance imaging of the spinal cord revealed a normal thoracic and lumbar spinal cord but a dissection of the thoracic aorta. Computed tomography angiography of the chest and abdominal aorta showed a Stanford type B dissection extending throughout the thoracic aorta and into the abdominal aorta hypomere.The patient died because of a sudden drop in blood pressure during transfer to vascular surgery.The clinical presentation of painless AAD mimics myelopathies.Aortic dissection should be considered in patients presenting with acute bilateral limb weakness.Physical examination of the skin temperature,dorsalis pedis artery,serum D-dimer,and myocardial markers can provide diagnostic clues.
文摘目的探讨D-二聚体及血栓弹力图(TEG)在预测全髋关节置换术后急性下肢深静脉血栓(DVT)中的意义。方法纳入2015年12月-2016年5月在该院关节外科行全髋关节置换的患者93例,动态监测置换前及置换后1、3、5、7和12 d的D-二聚体,并定期检测TEG各项指标,置换后12 d行双下肢静脉彩超,根据彩超结果有无血栓形成分为血栓组与对照组。对比两组患者D-二聚体及TEG各项指标的水平。结果患者术后定期行患侧肢体血管彩超检查,术后1周内行彩超检查未发现血栓形成,术后第12天彩超检查提示11例患者存在小腿肌间静脉血栓,纳入血栓组;其余82例患者未发现血栓,纳入对照组。两组患者在年龄、吸烟史,体重、手术时长及术中失血量比较,差异无统计学意义(P>0.05)。血栓组与对照组术前及术后1、3、5、7和12 d D-二聚体水平比较,差异有统计学意义(P<0.05),所有患者术后较术前凝血反应时间(R)缩短,血栓最大幅度(MA)升高,伴α角升高。术后第12天血栓组TEG的R时间、凝固时间、a角、MA、凝血块强度值及D-二聚体与对照组比较,差异有统计学意义(P<0.05)。结论提示髋关节置换术后D-二聚体的动态监测及TEG、小腿肌间静脉丛彩超检查有助于早期发现血栓。
基金This work was supported by a grant from the National Natural Science Foundation of China （30900459）, and it was also supported by the National 863 Hightechnology Program.
文摘BACKGROUND： Development of new coronary thrombolytic agents is hot in the market. A new drug, mutated recombinant tissue-type plasminogen activator （rtPAm）, is the product of mutation of tPA by changing binding loci with plasminogen activator inhibitor （PAl）-1 to reduce the degradation. In vitro test has demonstrated that the activity of rtPAm is much higher than rtPA in the absence of PAl. The present study is to observe the efficacy of mutated recombinant tissue-type plasminogen activator （rtPAm） in coronary thrombolytic therapy.METHODS： A total of 30 adult beagles were equally divided into 5 groups after thrombi： vehicle group, urokinase group, rtPAm low-dose group, rtPAm medium-dose group, and rtPAm high-dose group. Thrombolytic effect and myocardial infarction were observed after thrombolytic therapy.RESULTS： In the urokinase group, time to reperfusion was （15.8±3.8） minutes. TIMI 2 flow was demonstrated in 4 beagles, TIMI 3 flow in 2, and re-occlusion in 4 after 90 minutes respectively. In the low- dose rtPAm group, time to reperfusion was （15±4.5） minutes; TIMI 2 flow was demonstrated in 2 beagles, TIMI 3 flow in 4, and re-occlusion in 2 after 90 minutes. In the high-dose rtPAm group, time to reperfusion was （7.5±2.6） minutes. None of the beagles showed re-occlusion after 90 minutes. The infarction areas were （2.1±0.9）% in the medium-dose rtPAm group and （0.7±0.4）% in the high-dose rtPAm group, which decreased significantly than those in the low-dose rtPAm group. The aggregation rate in the medium-dose and high-dose rtPAm groups decreased significantly than that in the urokinase group.CONCLUSION： rtPAm may serve as a thrombolytic agent with platelet-targeted fibrinolysis and antiplatelet aggregation activities.
