Prostatic abscess of Klebsiella pneumoniae complicating septic pulmonary emboli and meningitis: A case report and brief review

Prostatic abscess is a rare entity with an incidence of 0.5% to 2.5% in all prostate diseases and usually occurs in the 5th and 6th decades of life with immunocompromised status,Prostatic abscess might be a process of evolution from acute prostatitis,Klebsiella pneumoniae is the leading microorganism in the diabetic patients of prostatic abscess in Taiwan,A 60-year-old diabetic man,with a one-week history of acute bacterial prostatitis was reported in this study,presenting to the emergency department with sudden altered mental status,The abdominal computed tomographic scan demonstrated lobulated prostatic abscess and multiple septic pulmonary emboli with lung abscesses,Analysis of cerebrospinal fluid showed white blood cells of 10 771 counts/mm3 with segmented neutrophils of 99%,Cultures of blood,cerebrospinal fluid and sputum yielded Klebsiella pneumoniae,We concluded that computed tomographic scan can make a definite diagnosis of prostatic abscess associated with complications and management with empiric antibiotics and adequate drainage is suggested.

Microembolic signal detection by transcranial Doppler: Old method with a new indication

Transcranial Doppler(TCD) is useful for investigation of intracranial arterial blood flow and can be used to detect a real-time embolic signal. Unfortunately, artefacts can mimic the embolic signal, complicating interpretation and necessitating expert-level opinion to distinguish the two. Resolving this situation is critical to achieve improved accuracy and utility of TCD for patients with disrupted intracranial arterial blood flow, such as stroke victims. A common type of stroke encountered in the clinic is cryptogenic stroke(or stroke with undetermined etiology), and patent foramen ovale(PFO) has been associated with the condition. An early clinical trial of PFO closure effect on secondary stroke prevention failed to demonstrate any benefit for the therapy, and research into the PFO therapy generally diminished. However, the recent publication of large randomized control trials with demonstrated benefit of PFO closure for recurrent stroke prevention has rekindled the interest in PFO in patients with cryptogenic stroke. To confirm that emboli across the PFO can reach the brain, TCD should be applied to detect the air embolic signal after injection of agitated saline bubbles at the antecubital vein. In addition, the automated embolic signal detection method should further facilitate use of TCD for air embolic signal detection after the agitated saline bubbles injection in patients with cryptogenic stroke and PFO.

Secondary craniofacial necrotizing fasciitis from a distant septic emboli: A case report

BACKGROUND Craniofacial necrotizing fasciitis(CNF)is an uncommon but fatal infection that can spread rapidly through the subfascial planes in the head and neck region.Symptoms usually progress rapidly,and early management is necessary to optimize outcomes.CASE SUMMARY A 43-year-old man visited our hospital with left hemifacial swelling involving the buccal and submandibular areas.The patient had fever for approximately 10 d before visiting the hospital,but did not report any other systemic symptoms.Computed tomography scan demonstrated an abscess with gas formation.After surgical drainage of the facial abscess,the patient’s systemic condition worsened and progressed to septic shock.Further examination revealed pulmonary and renal abscesses.Renal percutaneous catheter drainage was performed at the renal abscess site,which caused improvement of symptoms.The patient showed no evidence of systemic complications during the 4-mo post-operative follow-up period.CONCLUSION As the patient did not improve with conventional CNF treatment and symptoms only resolved after controlling the infection,the final diagnosis was secondary CNF with septic emboli.Aggressive surgical decompression is important for CNF management.However,if symptoms worsen despite early diagnosis and management,such as pus drainage and surgical intervention,clinicians should consider the possibility of a secondary abscess from internal organs.

Septic Superficial Femoral Vein Thrombophlebitis Causing Pulmonary Emboli and Respiratory Failure: Case Report and Review of the Literature

Septic pulmonary emboli rarely cause respiratory failure that requires mechanical ventilation. The most common causes of septic pulmonary emboli are related to intravenous drug abuse, indwelling intravenous catheters, endocarditis and septic pelvic thrombophlebitis. In addition, soft tissue injury-related thrombophlebitis rarely causes septic pulmonary emboli. We describe a unique case of a 43-year-old man who developed septic thrombophlebitis of the femoral vein following soft tissue injury from trauma to the shin with ensuing septic pulmonary emboli which necessitated endotracheal intubation and mechanical ventilation. The patient required mechanical ventilation for eleven days, developed empyema and grew out methicillin-resistant Staphylococcus aureus on blood cultures. A transesophageal echocardiogram was normal, and there was no indication of bacterial endocarditis. In addition to eleven days of mechanical ventilation, the patient was treated with intravenous heparin, cefepime and clindamycin. These medications were then discontinued and the patient was treated with weight-adjusted vancomycin. Following the return of cultures, the patient was treated for six weeks with ceftaroline 600 mg IV twice a day. In addition, the patient received bilateral thoracentesis followed by chest tube drainage until resolution of the pleural effusions. The patient made a complete recovery. We describe this case and the implications for differential diagnosis and treatment of these two uncommon conditions.

Monitoring the Sequelae of Coronary Microembolization on Myocardium Using Noninvasive Imaging (Review)

Acute myocardial infarction (AMI) is a leading cause of death worldwide. It has been clinically classified into 1) ischemic from a primary coronary event (e.g., plaque rupture or thrombotic occlusion), 2) ischemic from a supply-and-demand mismatch and c) ischemic from a percutaneous coronary interventions (PCI). Catheter-based PCI has been frequently used as an alternative to conventional bypass surgery for patients at high risk. However, this method of treatment is associated with microvascular obstruction (MVO) by dislodged microemboli that results in left ventricular (LV) dysfunction/remodeling, perfusion deficits, microinfarction and arrhythmia. The contributions of microemboli after revascularization of AMI have been acknowledged by major cardiac and interventional societies. Recent studies showed that Emboli Detection and Classification (EDAC) Quantifier offers increased sensitivity and capability for detecting dislodged coronary microemboli during PCI. Coronary microembolization can be detected directly by monitoring intra-myocardial contrast opacification on contrast echocardiography, increasing F-18 fluorodeoxyglucose (FDG) uptake on positron emission tomography, loss/diminution of signal on first pass perfusion and hypoenhanced zone on contrast enhanced magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) and indirectly by ST-segment elevation on electro-cardiography (ECG). The relations between volumes/sizes of microemboli, visibility of microinfarct, myocardial perfusion and LV function are still under intensive discussions. Non-invasive imaging can play important role in assessing these parameters. This review shed the light on the techniques used for detecting coronary microemboli, microvascular obstruction and microinfarct and the short- and long-term effects of microemboli on LV function, structure and perfusion.

Retinal emboli

Retinal emboli are opacities identified in retinal arterioles and are often incidental findings on ophthalmic examination. They are generally composed of cholesterol, platelet-fibrin, or calcium and are thought to arise from carotid arteries, coronary arteries, or cardiac valves. In the general population, the estimated prevalence is 0.2% to 1.3%, and the estimated incidence is 0.9% to 2.9%. The transient nature of retinal emboli likely explains the variations between and within these reported figures. The strongest risk factor for retinal emboli is smoking, which has been reported consistently across many studies. Other likely risk factors include older age, hypertension, male sex, total cholesterol, coronary artery disease, and history of coronary artery bypass grafting. The presence of multiple risk factors, as is common in many patients, confers a higher risk for retinal emboli. Several studies suggest that retinal emboli predict an increase in stroke-related, all-cause, and possibly cardiovascular mortality. Due to these sequelae, patients often undergo further workup, most commonly carotid ultrasonography. However, given the low prevalence of significant carotid disease in patients with retinal emboli, further workup, such as carotid ultrasound, should be reserved for those with risk factors for carotid disease. All patients would benefit from medical optimization and coordinated care with the primary care physician.

Perinatal arterial ischemic stroke and multiple thrombo-emboli in a term newborn

The etiology of perinatal arterial ischemic strokes may be maternal, fetal or both. Venous thrombo-embolism is almost always catheter associated in new-borns. Preliminary guidelines for management of perinatal arterial ischemic strokes exist but are mostly based on adult studies. We report a unique case of perinatal arterial ischemic stroke, lower extremity arterial and inferior vena-caval thrombosis. Our patient was treated with unfractionated heparin for 10 days then switched to low molecular heparin to complete 6 months of therapy. The patient responded well to therapy and shows minimal signs of permanent neurologic deficits after 6 months.

ABCD^(2) risk score does not predict the presence of cerebral microemboli in patients with hyper-acute symptomatic critical carotid artery stenosis

Introduction:ABCD^(2) risk score and cerebral microemboli detected by transcranial Doppler(TCD)have been separately shown to the predict risk of recurrent acute stroke.We studied whether ABCD2 risk score predicts cerebral microemboli in patients with hyper-acute symptomatic carotid artery stenosis.Participants and methods:We studied 206 patients presenting within 2 weeks of transient ischaemic attack or minor stroke and found to have critical carotid artery stenosis(≥50% ).86 patients(age 70±1(SEM:years),58 men,83 Caucasian)had evidence of microemboli;72(84% )of these underwent carotid endarterectomy(CEA).120 patients(age 72±1 years,91 men,113 Caucasian)did not have microemboli detected;102(85% )of these underwent CEA.Data were analysed using X2 and Mann–Whitney U tests and receiver operating characteristic(ROC)curves.Results:140/206(68% :95% CI 61.63 to 74.37)patients with hyper-acute symptomatic critical carotid stenosis had an ABCD2 risk score≥4.There was no significant difference in the NICE red flag criterion for early assessment(ABCD^(2) risk score≥4)for patients with cerebral microemboli versus those without microemboli(59/86 vs 81/120 patients:OR 1.05 ABCD2 risk score≥4(95% CI 0.58 to 1.90,p=0.867)).The ABCD2 risk score was<4 in 27 of 86(31% :95% CI 21 to 41)embolising patients and in 39 of 120(31% :95% CI 23 to 39)without cerebral microemboli.After adjusting for pre-neurological event antiplatelet treatment(APT),area under the curve(AUC)of ROC for ABCD2 risk score showed no prediction of cerebral microemboli(no pre-event APT,n=57:AUC 0.45(95% CI 0.29 to 0.60,p=0.531);preevent APT,n=147:AUC 0.51(95% CI 0.42 to 0.60,p=0.804)).Conclusions:The ABCD2 score did not predict the presence of cerebral microemboli or carotid disease in over one-quarter of patients with symptomatic critical carotid artery stenosis.On the basis of NICE guidelines(refer early if ABCD2≥4),assessment of high stroke risk based on ABCD2 scoring may lead to inappropriate delay in urgent treatment in many patients.

Simulation and feature analysis for gas emboli Doppler ultrasound signals

The purpose of this study is to establish the simulation model of the gas emboli by analyzing reasons for features of gas emboli Doppler ultrasound signals. It is useful for the further classification of the solid emboli and gas emboli. First, the model of the radiation force and the drag force is used to calculate forces acting on the gas emboli. Second, the acceleration of the gas emboli is calculated in both the radial direction and the axial direction of the vessel, which is used to calculate the trajectory of the gas emboli in the vessel. Finally, the computer simulation model is established for the gas emboli. Doppler ultrasound signals of the gas emboli and the solid emboli are generated in the simulation experiment. Experimental results show that compared with the solid emboli, the gas emboli acted by the radiation force and the drag force will result in the frequency-domain broaden in the Doppler spectrogram. When the gas emboli circulate from the low speed area to the high speed one and then from the high speed area back to the low speed one, a ＂V＂ shape will be shown in the spectrogram of gas emboli signals. When the gas emboli circulate from the low speed area to the high speed one or from the high speed area to the low speed one, a diagonal shape will be shown for gas emboli signals. It is also shown that features of simulated gas emboli signals match with those of gas emboli signals sampled from clinic. All demonstrate that the simulation method of the gas emboli is reasonable.

Anatomic distribution of embolus at CT pulmonary angiography in patients suspected acute pulmonary embolism

Objective To summarize and analyze the morphology and distribution of embolus in patients suspected acute pulmonary embolism. Methods The CT pulmonary angiography(CTPA) imagings of 279 patients suspected acute pulmonary embolism were analyzed retrospectively

Expression of tissue factor in pulmonary artery after experimental acute pulmonary embolism

Objective To investigate the expression of tissue factor and explore its clinical significances in pulmonary artery after acute pulmonary thromboembolism.Methods Thirty-four Japanese white rabbits(LevelⅡanimals)were randomly(random number)assigned into four groups:group A(specimen of pulmonary artery was taken 3 hours

IQon能谱CT碘图与单能量图对肺栓塞诊断的准确率对比

目的:对比IQon能谱CT碘图与单能量图对肺栓塞诊断的准确率。方法:选择2020年6月-2022年6月在苏州科技城医院进行CT检查的100疑似肺栓塞患者,所有患者均使用能谱模式进行扫描,通过系统软件对患者的CT碘图与单能量图进行分析,以肺动脉CT血管造影(CT angiography,CTA)为金标准,对比两种图像对肺栓塞检查的准确率、特异度、敏感度及肺动脉栓子诊断符合率。结果:100例疑似肺栓塞患者经肺动脉CTA检查确诊的患者88例,12例为非肺栓塞,碘图对肺栓塞诊断的准确率为97.00%,单能量图诊断的准确率为85.00%,碘图高于单能量图(P<0.05);碘图敏感度、特异度、阳性预测值、阴性预测值分别为97.73%、91.67%、98.90%、91.70%,单能量图诊断的敏感度、特异度、阳性预测值、阴性预测值分别为87.50%、66.67%、95.10%、42.11%,碘图与单能量图敏感度和阴性预测值差异均有统计学意义(P<0.05),特异度、阳性预测值差异均无统计学意义(P>0.05);在88例确诊患者中,肺动脉CTA检测出栓子共计106个,其中1级栓子数量为21个,2级37个,3级25个,4级23个;碘图检出1级栓子数量符合21个,2级36个,3级25个,4级22个;单能量图检出1级栓子数量符合15个,2级30个,3级18个,4级17个;碘图检查的符合率高于单能量图检查(P<0.05)。结论:碘图检查的准确率、敏感度、阴性预测值均高于单能量图,对于微小肺动脉栓子检查的符合率高于单能量图,为临床治疗提供依据。

原发性肝癌患者肝静脉压力梯度与门静脉压力梯度相关性研究

目的 探讨原发性肝癌患者肝静脉压力梯度(hepatic vein pressure gradient, HVPG)与门静脉压力梯度(portal pressure gradient, PPG)相关性。方法 161例原发性肝癌患者在TIPS术中测量下腔静脉压力(inferior vena cava pressure,ICVP)、肝静脉自由压(free hepatic vein pressure, FHVP)、肝静脉楔压(wedged hepatic vein pressure, WHVP)和门静脉压力(portal vein pressure, PVP),计算HVPG(HVPG=WHVP-FHVP)和PPG(PPG=PVP-IVCP)。结果 161例患者HVPG为(20.18±9.22)mmHg,PPG为(26.44±6.82)mmHg,2者无相关性(r=0.112);PPG明显高于HVPG (P <0.05)。HVPG与PPG相差在5 mmHg以上者90例,占55.9%,HVPG与PPG相差在5 mmHg以内者71例,占44.1%。球囊阻断肝静脉造影有肝内静脉-静脉侧支分流(intrahepatic venous-venous collateral shunt, HVVC)者42例(26.09%),HVPG为(10.91±6.11)mmHg,PPG为(28.43±6.11)mmHg,2者呈弱相关(r=0.384);PPG显著高于HVPG(P <0.05)。球囊阻断肝静脉造影无HVVC者119例,HVPG为(23.45±7.81)mmHg,PPG为(25.74±6.94) mmHg,2者呈弱相关(r=0.249);PPG明显高于HVPG(P <0.05)。结论 原发性肝癌合并门静脉高压(portal hypertension, PHT)HVPG与PPG总体相关性差,大部分患者的HVPG不能准确代表PPG,并且前者低于后者;有HVVC形成是严重低估HVPG值的重要原因。

Perioperative thrombotic complications in liver transplantation

Although the perioperative bleeding complications and the major side effects of blood transfusion have always been the primary concern in liver transplantation(OLT),the possible cohesion of an underestimated intrinsic hypercoagulative state during and after the transplant procedure may pose a major threat to both patient and graft survival.Thromboembolism during OLT is characterized not only by a complex aetiology,but also by unpredictable onset and evolution of the disease.The initiation of a procoagulant process may be triggered by various factors,such as inflammation,venous stasis,ischemia-reperfusion injury,vascular clamping,anatomical and technical abnormalities,genetic factors,deficiency of profibrinolytic activity,and platelet activation.The involvement of the arterial system,intracardiac thrombosis,pulmonary emboli,portal vein thrombosis,and deep vein thrombosis,are among the most serious thrombotic events in the perioperative period.The rapid detection of occlusive vascular events is of paramount importance as it heavily influences the prognosis,particularly when these events occur intraoperatively or early after OLT.Regardless of the lack of studies and guidelines on anticoagulant prophylaxis in this setting,many institutions recommend such an approach especially in the subset of patients at high risk.However,the decision of when,how and in what doses to use the various chemical anticoagulants is still a difficult task,since there is no common consensus,even for highrisk cases.The risk of postoperative thromboembolism causing severe hemodynamic events,or even loss of graft function,must be weighed and compared with the risk of an important bleeding.In this article we briefly review the risk factors and the possible predictors of major thrombotic complications occurringin the perioperative period,as well as their incidence and clinical features.Moreover,the indications to pharmacological prophylaxis and the current treatment strategies are also summarized.

磁性微球血管栓塞的实验研究

本文以磁性微球（ＭＧ－ｍｓ）为栓塞剂进行了实验研究。通过加磁场与不加磁场情况下行兔耳静脉注入￣（９９）ＴＣ标记的ＭＧ－ｍｓ试验、经导管犬肾动脉注入磁微粒（粒径＜１μｍ）和犬肝动脉注入１０～３０μｍＭＧ－ｍｓ的对比研究，显示磁微粒及磁微球有良好的体内磁应性。对１２只犬在加磁场与不加磁场下行肾动脉栓塞，结果有明显差异。对４只犬在加磁场的情况行１０～３０μｍＭＧ－ｍｓ肝动脉栓塞，效果满意。

近、远端保护装置在颈动脉重度狭窄支架治疗中的联合应用

目的总结联合应用近、远端保护装置经皮血管内支架治疗颈动脉重度狭窄的方法及经验。方法 2010年3-7月经造影确诊的颈动脉或颈内动脉颅外段重度狭窄患者5例,联合使用近端＋远端保护装置,经股动脉穿刺行颈动脉支架置入手术。结果除1例操作失败未能完成外,其余4例支架置入均获成功,术中未出现并发症,治疗效果满意。随访1~3个月,未出现脑缺血表现。结论对某些特殊颈动脉狭窄病变,在颈动脉支架置入术中联合应用近、远端保护装置,可弥补单一保护装置的不足,降低术中栓塞的风险,缩短术中血流中断时间,减少危险操作步骤,可作为颈动脉狭窄个体化治疗的选择。

腋淋巴结无转移乳腺癌组织内脉管密度及癌栓与组织蛋白酶D表达的研究

对１０５例ＡＮＮ乳腺癌的研究，发现癌组织及癌旁脉管内癌栓检出率为３１．４％，用ＵＥＡ－１及ＣＤ３４显示脉管密度，在有癌栓组平均每２００倍视野为１４３．２±４８．７个，在无癌栓组为９７．５±３７．６个，其差异有显著意义（Ｐ＜０．０１）。Ｃａｔｈ－Ｄ在乳腺癌细胞中的表达为６４．８％，其阳性表达在有癌栓组显著高于无癌栓组（Ｐ＜０．０５）。而间质细胞Ｃａｔｈ－Ｄ阳性表达程度与肿瘤大小，组织学分级，按预后好坏的组织学类型及脉管内癌栓等病理组织学指标均有显著相关性。结果提示，乳腺癌细胞及间质细胞Ｃａｔｈ－Ｄ阳性表达代表了肿瘤的侵袭性生物学行为，其中间质细胞Ｃａｔｈ－Ｄ阳性表达更有意义。

小鼠急性肺血栓栓塞症模型的建立与比较

目的通过评估不同方法诱导的肺血栓栓塞症小鼠模型效果,筛选建立操作简便、使用经济、成功率高的小鼠急性肺血栓栓塞症模型方法。方法制作全血血栓及白色血栓自体栓子,穿刺并注入小鼠右侧颈静脉,造成急性肺血栓栓塞症模型,分别于不同时间点检测相应生理、生化指标。结果经Mallory磷钨酸苏木精及HE染色证明,两种栓子制备肺血栓栓塞症模型的造模成功率为100%,栓子多处于肺动脉段及亚段水平,栓塞切实可靠;白色血栓栓塞组栓子较全血血栓组稳定性明显增高,自溶时间明显延长。结论白色血栓诱导的肺栓塞小鼠的病理状态更加稳定,且该急性肺血栓栓塞模型可以较好地模拟病理情况下这一疾病的病理、生理过程,为今后进一步研究肺血栓栓塞症的病理机制与筛选药物提供了一定的实验基础。

肾动静脉畸形九例的DSA造影表现及介入栓塞治疗

目的 探讨肾动静脉畸形（AVM）DSA造影诊断及介入栓塞治疗的价值。方法 回顾性分析2007年1月至2013年1月9例突发性全程肉眼血尿患者。DSA选择性或超选择性造影明确诊断为肾AVM，并了解病变性质、部位、范围、程度，然后选择靶血管进行栓塞治疗。栓塞材料包括海绵颗粒、丝线颗粒及弹簧圈。栓塞方式：丝线颗粒结合海绵颗粒；丝线颗粒、海绵颗粒结合弹簧圈；单纯弹簧圈等。术后随访1 ～ 24个月。结果 9例患者经DSA明确诊断为静脉曲张型肾AVM，清晰显示供血动脉、引流静脉及畸形血管团。病变位于左肾3例，右肾6例。8例成功进行栓塞治疗，1例病变范围广泛且伴健侧肾重度萎缩放弃治疗。采取丝线颗粒结合海绵颗粒栓塞1例，丝线颗粒、海绵颗粒结合弹簧圈6例，单纯弹簧圈栓塞1例。术后肉眼血尿明显减轻，36 h内消失。随访期间未见血尿复发及严重并发症发生。结论DSA是诊断肾AVM的金标准，介入栓塞治疗具有微创、疗效好等特点，可作为该疾病的首选治疗方案。

颅内动脉瘤介入治疗20例疗效分析

目的：观察血管内弹簧圈栓塞治疗颅内动脉瘤的临床疗效,并探讨术中操作注意事项。方法：对20例颅内动脉瘤患者施行血管内弹簧圈栓塞治疗,其中2例宽瘤颈动脉瘤采用支架辅助弹簧圈栓塞治疗。20例术前均经数字减影血管造影（DSA）检查明确诊断。结果：19例术中栓塞满意,其中1例术中动脉瘤破裂,4天后死亡;1例术后3天并发右侧大脑后动脉梗塞,2天后死亡。15例患者术后6~8个月随访行DSA复查,瘤体栓塞完全,载瘤动脉通畅。结论：弹簧圈栓塞治疗颅内动脉瘤是一种安全、有效的治疗方法,根据动脉瘤具体形态联合运用多种栓塞技术可提高动脉瘤栓塞的治愈率。