Acute myocardial infarction is the main cause of human death.Traditional Chinese medicine,as an important part of the wisdom of the Chinese nation,plays an important role in the treatment of myocardial infarction.Comb...Acute myocardial infarction is the main cause of human death.Traditional Chinese medicine,as an important part of the wisdom of the Chinese nation,plays an important role in the treatment of myocardial infarction.Combining the latest research on the treatment of acute myocardial infarction with traditional Chinese medicine and related literature reports,it summarizes the theories and treatments of traditional Chinese medicine,aiming to provide clinicians with ideas and references in clinical diagnosis and treatment.展开更多
Objective:To explore the effect of establishing a WeChat platform for a chest pain center as a medium to increase the treatment speed and improve the prognosis of patients with acute ST-segment elevation myocardial in...Objective:To explore the effect of establishing a WeChat platform for a chest pain center as a medium to increase the treatment speed and improve the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Methods:The chest pain center,established by the creation of a WeChat group,included primary hospitals in Chongqing that are not able to perform PPCI and the First Affi liated Hospital of Chongqing Medical University,which is the core of the center and which includes medical staff of the catheter laboratory,the cardiology department,the emergency,the vascular surgery department,and the cardiothoracic surgery department.Patients with acute STEMI who underwent PPCI from January 2017 to November 2018 in the First Affi liated Hospital of Chongqing Medical University were enrolled.The patients(including emergency department visitors,120 callers,and patients transferred from the critical care unit or other departments)were divided into a WeChat pre-admission startup group(n=311)and a non-WeChat pre-admission startup group(control group,n=172).Patients’door-to-balloon time,standard door-toballoon time achievement rate,artery puncture to balloon dilation time,heart failure rate,length of stay,and incidence of adverse events(including fatal arrhythmia,cardiogenic shock,and death)during hospitalization were compared between the two groups.Results:Four hundred eight-three consecutive patients were enrolled.There was no signifi cant difference in patients’sex,age,length of stay,and cardiovascular events during hospitalization between the two groups(P>0.05).The door-to-balloon time of the patients in the WeChat pre-admission startup group was much shorter than that of patients in the non-WeChat pre-admission startup group(27.35±10.58 min vs.88.15±53.79 min,P<0.05).The standard door-to-balloon time achievement rate was signifi cantly higher in the WeChat pre-admission startup group than in the non-WeChat pre-admission startup group(100%vs.72.09%,P<0.05).Conclusion:The application of a WeChat platform signifi cantly shortened the door-to-balloon time of patients receiving PPCI and increased the standard door-to-balloon time achievement rate for patients with STEMI.In addition,the platform is also conducive to integrating medical resources and sharing medical information.The establishment of the platform increased the treatment speed and improved the prognosis of patients with STEMI.展开更多
BACKGROUND With the spread and establishment of the Chest Pain Center in China,adhering to the idea that“time is myocardial cell and time is life”,many hospitals have set up a standardized process that ensures that ...BACKGROUND With the spread and establishment of the Chest Pain Center in China,adhering to the idea that“time is myocardial cell and time is life”,many hospitals have set up a standardized process that ensures that patients with acute myocardial infarction(AMI)who meet emergency percutaneous coronary intervention(PCI)guidelines are sent directly to the DSA room by the prehospital emergency doctor,saving the time spent on queuing,registration,payment,re-examination by the emergency doctor,and obtaining consent for surgery after arriving at the hospital.Takotsubo cardiomyopathy is an acute disease that is triggered by intense emotional or physical stress and must be promptly differentiated from AMI for its appropriate management.CASE SUMMARY A 52-year-old female patient was taken directly to the catheterization room to perform PCI due to 4 h of continuous thoracalgia and elevation of the ST segment in the V3–V5 lead,without being transferred to the emergency department according to the Chest Pain Center model.Loading doses of aspirin,clopidogrel and statins were administered and informed consent for PCI was signed in the ambulance.On first look,the patient looked nervous in the DSA room.Coronary angiography showed no obvious stenosis.Left ventricular angiography showed that the contraction of the left ventricular apex was weakened,and the systolic period was ballooning out,showing a typical“octopus trap”change.The patient was diagnosed with Takotsubo cardiomyopathy.Five days later,the patient had no symptoms of thoracalgia,and the serological indicators returned to normal.She was discharged with a prescription of medication.CONCLUSION Under the Chest Pain Center model for the treatment of patients with chest pain showing ST segment elevation,despite the urgency of time,Takotsubo cardiomy-opathy must be promptly differentiated from AMI for its appropriate management.展开更多
Background The benefit of statin use after acute ST-segment elevation myocardial infarction （STEMI） has been well established, however, the influence of the timing of statin administration has not been elucidated. T...Background The benefit of statin use after acute ST-segment elevation myocardial infarction （STEMI） has been well established, however, the influence of the timing of statin administration has not been elucidated. The objective of this study focused on early clinical outcomes after percutaneous coronary intervention （PCI）. Methods This analysis of the Korea Working Group on Myocardial Infarction registry （KorMI） study included 3,584 STEMI patients （mean age, 63 ±13 years;male, 2,684, 74.9%） undergoing PCI from January 2008 to June 2009. Rates of major adverse cardiac events （MACE：all-cause death, recurrent MI, and target lesion revascularization） were compared among patients grouped according to statin therapy timing：I, both during and after hospitalization （n=2,653, 74%）;II, only during hospita-lization （n=309, 8.6%）;III, only after discharge （n=157, 4.4%）;and IV, no statin therapy （n=465, 13%）. Mean follow-up duration was 234 ± 113 days. Results Multivariate factors of statin use during hospitalization included prior statin use, multiple diseased vessels, final thrombolysis in myocardial infarction flow grade III, and low-density lipoprotein cholesterol level. At 6-month follow-up, groups Ⅲ and Ⅳ had the highest MACE rates （2.3%, 3.9%, 5.1%, and 4.9%for groups I-IV, respectively, P=0.004）. After adjusting for confounders, groups Ⅱ-Ⅳ had a higher MACE risk than group Ⅰ [hazard ratio （HR）：3.20, 95%confidence interval （95%CI）：1.31-7.86, P=0.011;HR：3.84, 95%CI：1.47-10.02, P=0.006;and HR：3.17, 95%CI：1.59-6.40, P=0.001;respectively]. Conclusions This study, based on the national registry database, shows early and continuous statin therapy improvs early outcomes of STEMI patients after PCI in real-world clinical prac-tice.展开更多
BACKGROUND Acute chest pain(ACP)is very common among patients presenting to emergency departments.Nevertheless,ACP caused by esophageal foreign body is relatively rarely reported.CASE SUMMARY A 56-year-old man sufferi...BACKGROUND Acute chest pain(ACP)is very common among patients presenting to emergency departments.Nevertheless,ACP caused by esophageal foreign body is relatively rarely reported.CASE SUMMARY A 56-year-old man suffering from chest pain(increased pain for the last 9 h)was admitted to our hospital on October 25,2015.After undergoing physical examination and laboratory blood testing,he was diagnosed with acute anterior myocardial infarction.Consequently,the patient underwent emergency percutaneous coronary angiography;however,no myocardial infarction signs were observed.Later on,the patient experienced respiration failure and therefore was transferred to intensive care unit.Cardiac ultrasound showed pericardial effusion,which was considered as the cause of shock.He then underwent pericardium puncture drainage and the circulation temporarily improved.Nevertheless,persistent pericardial bleeding,unclear bleeding causes,and clot formation induced poor drainage led to worsening of cardiac tamponade symptoms.Consequently,the patient underwent emergency exploratory thoracotomy,which revealed a fish bone causing pericardial bleeding.The bone was removed,and the damaged blood vessels were mended.Eventually,the patient was discharged in good clinical condition.CONCLUSION For patients with chest pain,it is necessary to consider the possibility of foreign body in the esophagus or even in the heart.Careful history taking and the corresponding inspection can help to avoid unnecessary damage and safeguard patients from unnecessary pain.展开更多
BACKGROUND Pheochromocytoma is a rare endocrine tumor arising from chromaffin cells and having extensive and profound effects on the cardiovascular system by continuously or intermittently releasing catecholamines.The...BACKGROUND Pheochromocytoma is a rare endocrine tumor arising from chromaffin cells and having extensive and profound effects on the cardiovascular system by continuously or intermittently releasing catecholamines.The clinical manifestations of pheochromocytoma are diverse,and the typical triad,including episodic headache,palpitations,and sweating,only occurs in 24%of pheochromocytoma patients,which often misleads clinicians into making an incorrect diagnosis.We herein report the case of a patient with intermittent chest pain and elevated myocardial enzymes for 2 years who was diagnosed with pheochromocytoma.CASE SUMMARY A 49-year-old woman presented with intermittent chest pain for 2 years.Two years ago,the patient experienced chest pain and was diagnosed with acute myocardial infarction,with 25%stenosis in the left circumflex.The patient still had intermittent chest pain after discharge.Two hours before admission to our hospital,the patient experienced chest pain with nausea and vomiting,lasting for 20 min.Troponin I and urinary norepinephrine and catecholamine levels were elevated.An electrocardiogram indicated QT prolongation and ST-segment depression in leads II,III,aVF,and V3-V6.A coronary computed tomography angiogram revealed no evidence of coronary artery disease.Echocardiography showed left ventricular enlargement and a decreased posterior inferior wall motion amplitude.Contrast-enhanced computed tomography demonstrated an inhomogeneous right adrenal mass.The patient successfully underwent laparoscopic right adrenalectomy,and histopathology confirmed adrenal pheochromocytoma.During the first-year follow-up visits,the patient was asymptomatic.The abnormal changes on echocardiography and electro-cardiogram disappeared.CONCLUSION Clinicians should be aware of pheochromocytoma.A timely and accurate diagnosis of pheochromocytoma is essential for alleviating serious cardiac complications.展开更多
Objective:To investigate the treatment and prevention of acute myocardial infarction after colon cancer surgery.Methods:A patient with acute anterior myocardial infarction who underwent stent implantation in the Seven...Objective:To investigate the treatment and prevention of acute myocardial infarction after colon cancer surgery.Methods:A patient with acute anterior myocardial infarction who underwent stent implantation in the Seventh Affiliated Hospital,Sun Yat-sen University in 2017 was selected as the subject.The patient was admitted to the emergency department for stent implantation and took antiplatelet and lipid regulating drugs orally on time after the operation.The patient also had a history of colon cancer.The lesion was resected,and the complication after operation was acute myocardial infarction.After active and effective treatment and intervention,the treatment effect of the patient was analyzed.Results:Urgent PTCA was performed,and 0.5 mg Tirofiban was injected into the coronary artery.The results of angiography showed that the blood flow of anterior descending branch recovered to grade 2.Conclusion:The condition of patients with myocardial infarction after colon cancer surgery changes rapidly.Surgery combined with drug treatment can achieve a good prognosis,reduce mortality,and improve patients’cardiac function.展开更多
BACKGROUND Upper gastrointestinal bleeding(UGIB) after an acute myocardial infarction(AMI) is not an uncommon complication. Acute UGIB caused by Mallory-Weiss syndrome(MWS) is usually a dire situation with massive ble...BACKGROUND Upper gastrointestinal bleeding(UGIB) after an acute myocardial infarction(AMI) is not an uncommon complication. Acute UGIB caused by Mallory-Weiss syndrome(MWS) is usually a dire situation with massive bleeding and hemodynamic instability. Acute UGIB caused by MWS after an AMI has not been previously reported.CASE SUMMARY A 57-year-old man with acute inferior wall ST elevation myocardial infarction underwent a primary coronary intervention of the acutely occluded right coronary artery. Six hours after the intervention, the patient had a severe UGIB,followed by vomiting. His hemoglobin level dropped from 15.3 g/d L to 9.7 g/d L. In addition to blood transfusion and a gastric acid inhibition treatment,early endoscopy was employed and MWS was diagnosed. Bleeding was stopped by endoscopic placement of titanium clips.CONCLUSION Bleeding complications after stent implantation can pose a dilemma. MWS is a rare but severe cause of acute UGIB after an AMI that requires an early endoscopic diagnosis and a hemoclip intervention to stop bleeding.展开更多
Background: Acute intestinal ischemia is an abdominal suffering occasioned by a sudden reduction of mesenteric blood circulation. It is a rare and potentially serious medical-surgical emergency, deadly in 50% to 100% ...Background: Acute intestinal ischemia is an abdominal suffering occasioned by a sudden reduction of mesenteric blood circulation. It is a rare and potentially serious medical-surgical emergency, deadly in 50% to 100% of cases. Diagnosis is known to be difficult at the early stage during which a well-conducted treatment may help reduce mortality. Multi-detector scanners were assessed to be far more sensitive and appropriate for the diagnosis of mesenteric ischemia than angiography. Objective: Study the tomodensitometric aspects of acute intestinal ischemia, and the traps of late diagnosis, in order to optimize the care and improve the prognosis of this disease. Patients and Methods: This is a prospective, longitudinal and descriptive study covering a period of nine (9) months. We have included all cases of acute intestinal ischemia. Results: Twenty (20) cases of acute intestinal ischemia were registered i.e. a frequency of 2.2 cases per month. The average age of the patients was 67.8 years with 0.7 as sex ratio. Abdominal pain was noted in all cases. History of cardiovascular disease was found in seven (7) cases. Abdominal angioscan was performed in fifteen (15) cases. There was a suspected diagnosis upon request in ten (10) cases. The main intestinal lesions were the lack of parietal enhancement (13 cases) and parietal thickening (12 cases). There were sixteen (16) cases of acute mesenteric ischemia and four (4) cases of ischemic colitis. The acute mesenteric ischemia was arterial in eleven (11) cases, venous in two (2) cases and mixed in two (2) cases. Diagnosis was made at the stage of intestinal infarction in eleven (11) cases. Ten (10) patients were operated and 10 others were treated medically. Thirteen (13) cases of death were registered. Conclusion: Acute intestinal ischemia is a rare but serious disease. Abdominal pain is the main ground for consultation. Diagnosis is often late and focuses on abdominal CT angiography. An early diagnosis could help improve its prognosis.展开更多
Duchenne Muscular Dystrophy （DMD） is an X- linked disorder and presents in boys of early childhood with proximal muscle weak- ness, calf hypertrophy and markedly elevated creatine kinase levels. Weakness in DMD is p...Duchenne Muscular Dystrophy （DMD） is an X- linked disorder and presents in boys of early childhood with proximal muscle weak- ness, calf hypertrophy and markedly elevated creatine kinase levels. Weakness in DMD is progressive, and ambulation is lost early in the second decade1. The main clinical features of the patients are the proximal muscle weakness and atrophy, unusual walking posture,展开更多
BACKGROUND Idiopathic omental infarction(IOI)is challenging to diagnose due to its low incidence and vague symptoms.Its differential diagnosis also poses difficulties because it can mimic many intra-abdominal organ pa...BACKGROUND Idiopathic omental infarction(IOI)is challenging to diagnose due to its low incidence and vague symptoms.Its differential diagnosis also poses difficulties because it can mimic many intra-abdominal organ pathologies.Although hypercoagulability and thrombosis are among the causes of omental infarction,venous thromboembolism scanning is rarely performed as an etiological investigation.CASE SUMMARY The medical records of the 5 cases,who had the diagnosis of IOI by computed tomography,were examined.The majority of the patients were male(n=4,80%)and the mean age was 31 years(range:21-38).The patients had no previous abdominal surgery or a history of any chronic disease.The main complaint of all patients was persistent abdominal pain.Omental infarction was detected in all patients with contrast-enhanced computed tomography.Conservative treatment was initially preferred in all patients,but it failed in 1 patient(20%).After discharge,all patients were referred to the hematology department for thrombophilia screening.Only 1 patient applied for thrombophilia screening and was homozygous for methylenetetrahydrofolate reductase(A1298C mutation)and heterozygous for a factor V Leiden mutation.CONCLUSION IOI should be considered in the differential diagnosis in patients presenting with progressive and/or persistent right side abdominal pain.Investigating risk factors such as hypercoagulability in patients with IOI is also important in preventing future conditions related to venous thromboembolism.展开更多
文摘Acute myocardial infarction is the main cause of human death.Traditional Chinese medicine,as an important part of the wisdom of the Chinese nation,plays an important role in the treatment of myocardial infarction.Combining the latest research on the treatment of acute myocardial infarction with traditional Chinese medicine and related literature reports,it summarizes the theories and treatments of traditional Chinese medicine,aiming to provide clinicians with ideas and references in clinical diagnosis and treatment.
文摘Objective:To explore the effect of establishing a WeChat platform for a chest pain center as a medium to increase the treatment speed and improve the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Methods:The chest pain center,established by the creation of a WeChat group,included primary hospitals in Chongqing that are not able to perform PPCI and the First Affi liated Hospital of Chongqing Medical University,which is the core of the center and which includes medical staff of the catheter laboratory,the cardiology department,the emergency,the vascular surgery department,and the cardiothoracic surgery department.Patients with acute STEMI who underwent PPCI from January 2017 to November 2018 in the First Affi liated Hospital of Chongqing Medical University were enrolled.The patients(including emergency department visitors,120 callers,and patients transferred from the critical care unit or other departments)were divided into a WeChat pre-admission startup group(n=311)and a non-WeChat pre-admission startup group(control group,n=172).Patients’door-to-balloon time,standard door-toballoon time achievement rate,artery puncture to balloon dilation time,heart failure rate,length of stay,and incidence of adverse events(including fatal arrhythmia,cardiogenic shock,and death)during hospitalization were compared between the two groups.Results:Four hundred eight-three consecutive patients were enrolled.There was no signifi cant difference in patients’sex,age,length of stay,and cardiovascular events during hospitalization between the two groups(P>0.05).The door-to-balloon time of the patients in the WeChat pre-admission startup group was much shorter than that of patients in the non-WeChat pre-admission startup group(27.35±10.58 min vs.88.15±53.79 min,P<0.05).The standard door-to-balloon time achievement rate was signifi cantly higher in the WeChat pre-admission startup group than in the non-WeChat pre-admission startup group(100%vs.72.09%,P<0.05).Conclusion:The application of a WeChat platform signifi cantly shortened the door-to-balloon time of patients receiving PPCI and increased the standard door-to-balloon time achievement rate for patients with STEMI.In addition,the platform is also conducive to integrating medical resources and sharing medical information.The establishment of the platform increased the treatment speed and improved the prognosis of patients with STEMI.
基金Supported by the National Natural Science Foundation of ChinaNo. 82000252
文摘BACKGROUND With the spread and establishment of the Chest Pain Center in China,adhering to the idea that“time is myocardial cell and time is life”,many hospitals have set up a standardized process that ensures that patients with acute myocardial infarction(AMI)who meet emergency percutaneous coronary intervention(PCI)guidelines are sent directly to the DSA room by the prehospital emergency doctor,saving the time spent on queuing,registration,payment,re-examination by the emergency doctor,and obtaining consent for surgery after arriving at the hospital.Takotsubo cardiomyopathy is an acute disease that is triggered by intense emotional or physical stress and must be promptly differentiated from AMI for its appropriate management.CASE SUMMARY A 52-year-old female patient was taken directly to the catheterization room to perform PCI due to 4 h of continuous thoracalgia and elevation of the ST segment in the V3–V5 lead,without being transferred to the emergency department according to the Chest Pain Center model.Loading doses of aspirin,clopidogrel and statins were administered and informed consent for PCI was signed in the ambulance.On first look,the patient looked nervous in the DSA room.Coronary angiography showed no obvious stenosis.Left ventricular angiography showed that the contraction of the left ventricular apex was weakened,and the systolic period was ballooning out,showing a typical“octopus trap”change.The patient was diagnosed with Takotsubo cardiomyopathy.Five days later,the patient had no symptoms of thoracalgia,and the serological indicators returned to normal.She was discharged with a prescription of medication.CONCLUSION Under the Chest Pain Center model for the treatment of patients with chest pain showing ST segment elevation,despite the urgency of time,Takotsubo cardiomy-opathy must be promptly differentiated from AMI for its appropriate management.
文摘Background The benefit of statin use after acute ST-segment elevation myocardial infarction （STEMI） has been well established, however, the influence of the timing of statin administration has not been elucidated. The objective of this study focused on early clinical outcomes after percutaneous coronary intervention （PCI）. Methods This analysis of the Korea Working Group on Myocardial Infarction registry （KorMI） study included 3,584 STEMI patients （mean age, 63 ±13 years;male, 2,684, 74.9%） undergoing PCI from January 2008 to June 2009. Rates of major adverse cardiac events （MACE：all-cause death, recurrent MI, and target lesion revascularization） were compared among patients grouped according to statin therapy timing：I, both during and after hospitalization （n=2,653, 74%）;II, only during hospita-lization （n=309, 8.6%）;III, only after discharge （n=157, 4.4%）;and IV, no statin therapy （n=465, 13%）. Mean follow-up duration was 234 ± 113 days. Results Multivariate factors of statin use during hospitalization included prior statin use, multiple diseased vessels, final thrombolysis in myocardial infarction flow grade III, and low-density lipoprotein cholesterol level. At 6-month follow-up, groups Ⅲ and Ⅳ had the highest MACE rates （2.3%, 3.9%, 5.1%, and 4.9%for groups I-IV, respectively, P=0.004）. After adjusting for confounders, groups Ⅱ-Ⅳ had a higher MACE risk than group Ⅰ [hazard ratio （HR）：3.20, 95%confidence interval （95%CI）：1.31-7.86, P=0.011;HR：3.84, 95%CI：1.47-10.02, P=0.006;and HR：3.17, 95%CI：1.59-6.40, P=0.001;respectively]. Conclusions This study, based on the national registry database, shows early and continuous statin therapy improvs early outcomes of STEMI patients after PCI in real-world clinical prac-tice.
基金Supported by The Key Medical Disciplines of Jiaxing-Critical Care Med(Supporting Subject),No.2019-zc-12
文摘BACKGROUND Acute chest pain(ACP)is very common among patients presenting to emergency departments.Nevertheless,ACP caused by esophageal foreign body is relatively rarely reported.CASE SUMMARY A 56-year-old man suffering from chest pain(increased pain for the last 9 h)was admitted to our hospital on October 25,2015.After undergoing physical examination and laboratory blood testing,he was diagnosed with acute anterior myocardial infarction.Consequently,the patient underwent emergency percutaneous coronary angiography;however,no myocardial infarction signs were observed.Later on,the patient experienced respiration failure and therefore was transferred to intensive care unit.Cardiac ultrasound showed pericardial effusion,which was considered as the cause of shock.He then underwent pericardium puncture drainage and the circulation temporarily improved.Nevertheless,persistent pericardial bleeding,unclear bleeding causes,and clot formation induced poor drainage led to worsening of cardiac tamponade symptoms.Consequently,the patient underwent emergency exploratory thoracotomy,which revealed a fish bone causing pericardial bleeding.The bone was removed,and the damaged blood vessels were mended.Eventually,the patient was discharged in good clinical condition.CONCLUSION For patients with chest pain,it is necessary to consider the possibility of foreign body in the esophagus or even in the heart.Careful history taking and the corresponding inspection can help to avoid unnecessary damage and safeguard patients from unnecessary pain.
基金the Natural Science Basic Research Program of Shaanxi Province,No.2020JQ-939and the Science and Technology Development Incubation Fund Project of Shaanxi Provincial People’s Hospital,No.2019YXQ-08.
文摘BACKGROUND Pheochromocytoma is a rare endocrine tumor arising from chromaffin cells and having extensive and profound effects on the cardiovascular system by continuously or intermittently releasing catecholamines.The clinical manifestations of pheochromocytoma are diverse,and the typical triad,including episodic headache,palpitations,and sweating,only occurs in 24%of pheochromocytoma patients,which often misleads clinicians into making an incorrect diagnosis.We herein report the case of a patient with intermittent chest pain and elevated myocardial enzymes for 2 years who was diagnosed with pheochromocytoma.CASE SUMMARY A 49-year-old woman presented with intermittent chest pain for 2 years.Two years ago,the patient experienced chest pain and was diagnosed with acute myocardial infarction,with 25%stenosis in the left circumflex.The patient still had intermittent chest pain after discharge.Two hours before admission to our hospital,the patient experienced chest pain with nausea and vomiting,lasting for 20 min.Troponin I and urinary norepinephrine and catecholamine levels were elevated.An electrocardiogram indicated QT prolongation and ST-segment depression in leads II,III,aVF,and V3-V6.A coronary computed tomography angiogram revealed no evidence of coronary artery disease.Echocardiography showed left ventricular enlargement and a decreased posterior inferior wall motion amplitude.Contrast-enhanced computed tomography demonstrated an inhomogeneous right adrenal mass.The patient successfully underwent laparoscopic right adrenalectomy,and histopathology confirmed adrenal pheochromocytoma.During the first-year follow-up visits,the patient was asymptomatic.The abnormal changes on echocardiography and electro-cardiogram disappeared.CONCLUSION Clinicians should be aware of pheochromocytoma.A timely and accurate diagnosis of pheochromocytoma is essential for alleviating serious cardiac complications.
文摘Objective:To investigate the treatment and prevention of acute myocardial infarction after colon cancer surgery.Methods:A patient with acute anterior myocardial infarction who underwent stent implantation in the Seventh Affiliated Hospital,Sun Yat-sen University in 2017 was selected as the subject.The patient was admitted to the emergency department for stent implantation and took antiplatelet and lipid regulating drugs orally on time after the operation.The patient also had a history of colon cancer.The lesion was resected,and the complication after operation was acute myocardial infarction.After active and effective treatment and intervention,the treatment effect of the patient was analyzed.Results:Urgent PTCA was performed,and 0.5 mg Tirofiban was injected into the coronary artery.The results of angiography showed that the blood flow of anterior descending branch recovered to grade 2.Conclusion:The condition of patients with myocardial infarction after colon cancer surgery changes rapidly.Surgery combined with drug treatment can achieve a good prognosis,reduce mortality,and improve patients’cardiac function.
基金Supported by National Natural Science Foundation of China,No.81570360Beijing Lisheng Cardiovascular Grant,No.LHJJ201612425
文摘BACKGROUND Upper gastrointestinal bleeding(UGIB) after an acute myocardial infarction(AMI) is not an uncommon complication. Acute UGIB caused by Mallory-Weiss syndrome(MWS) is usually a dire situation with massive bleeding and hemodynamic instability. Acute UGIB caused by MWS after an AMI has not been previously reported.CASE SUMMARY A 57-year-old man with acute inferior wall ST elevation myocardial infarction underwent a primary coronary intervention of the acutely occluded right coronary artery. Six hours after the intervention, the patient had a severe UGIB,followed by vomiting. His hemoglobin level dropped from 15.3 g/d L to 9.7 g/d L. In addition to blood transfusion and a gastric acid inhibition treatment,early endoscopy was employed and MWS was diagnosed. Bleeding was stopped by endoscopic placement of titanium clips.CONCLUSION Bleeding complications after stent implantation can pose a dilemma. MWS is a rare but severe cause of acute UGIB after an AMI that requires an early endoscopic diagnosis and a hemoclip intervention to stop bleeding.
文摘Background: Acute intestinal ischemia is an abdominal suffering occasioned by a sudden reduction of mesenteric blood circulation. It is a rare and potentially serious medical-surgical emergency, deadly in 50% to 100% of cases. Diagnosis is known to be difficult at the early stage during which a well-conducted treatment may help reduce mortality. Multi-detector scanners were assessed to be far more sensitive and appropriate for the diagnosis of mesenteric ischemia than angiography. Objective: Study the tomodensitometric aspects of acute intestinal ischemia, and the traps of late diagnosis, in order to optimize the care and improve the prognosis of this disease. Patients and Methods: This is a prospective, longitudinal and descriptive study covering a period of nine (9) months. We have included all cases of acute intestinal ischemia. Results: Twenty (20) cases of acute intestinal ischemia were registered i.e. a frequency of 2.2 cases per month. The average age of the patients was 67.8 years with 0.7 as sex ratio. Abdominal pain was noted in all cases. History of cardiovascular disease was found in seven (7) cases. Abdominal angioscan was performed in fifteen (15) cases. There was a suspected diagnosis upon request in ten (10) cases. The main intestinal lesions were the lack of parietal enhancement (13 cases) and parietal thickening (12 cases). There were sixteen (16) cases of acute mesenteric ischemia and four (4) cases of ischemic colitis. The acute mesenteric ischemia was arterial in eleven (11) cases, venous in two (2) cases and mixed in two (2) cases. Diagnosis was made at the stage of intestinal infarction in eleven (11) cases. Ten (10) patients were operated and 10 others were treated medically. Thirteen (13) cases of death were registered. Conclusion: Acute intestinal ischemia is a rare but serious disease. Abdominal pain is the main ground for consultation. Diagnosis is often late and focuses on abdominal CT angiography. An early diagnosis could help improve its prognosis.
基金supported by the Natural Science Foundation of China(No.81570382)
文摘Duchenne Muscular Dystrophy （DMD） is an X- linked disorder and presents in boys of early childhood with proximal muscle weak- ness, calf hypertrophy and markedly elevated creatine kinase levels. Weakness in DMD is progressive, and ambulation is lost early in the second decade1. The main clinical features of the patients are the proximal muscle weakness and atrophy, unusual walking posture,
文摘BACKGROUND Idiopathic omental infarction(IOI)is challenging to diagnose due to its low incidence and vague symptoms.Its differential diagnosis also poses difficulties because it can mimic many intra-abdominal organ pathologies.Although hypercoagulability and thrombosis are among the causes of omental infarction,venous thromboembolism scanning is rarely performed as an etiological investigation.CASE SUMMARY The medical records of the 5 cases,who had the diagnosis of IOI by computed tomography,were examined.The majority of the patients were male(n=4,80%)and the mean age was 31 years(range:21-38).The patients had no previous abdominal surgery or a history of any chronic disease.The main complaint of all patients was persistent abdominal pain.Omental infarction was detected in all patients with contrast-enhanced computed tomography.Conservative treatment was initially preferred in all patients,but it failed in 1 patient(20%).After discharge,all patients were referred to the hematology department for thrombophilia screening.Only 1 patient applied for thrombophilia screening and was homozygous for methylenetetrahydrofolate reductase(A1298C mutation)and heterozygous for a factor V Leiden mutation.CONCLUSION IOI should be considered in the differential diagnosis in patients presenting with progressive and/or persistent right side abdominal pain.Investigating risk factors such as hypercoagulability in patients with IOI is also important in preventing future conditions related to venous thromboembolism.
