Pulmonary vein thrombosis in a patient with polycythemia vera

Pulmonary vein thrombosis(PVT) is a rarely encountered disease entity with varied clinical presentations. It is usually associated with lung carcinoma, lung surgeries and as a complication of the radiofrequency catheter ablation procedure for atrial fibrillation. Its clinical manifestations can vary from mild hemoptysis to lung infarction with hemodynamic compromise. A 76-year-old male presented with a 2-d history of pleuritic left sided chest pain. His past medical history included polycythemia vera, atrial fibrillation, coronary artery disease, pulmonary embolism and pulmonary hypertension. Chest radiograph was normal, troponins were normal and the 12-lead electrocardiogram did not show any ischemic changes. A computerized tomography pulmonary angiogram revealed a filling defect in the left lower lobe pulmonary vein. He was treated with subcutaneous enoxaparin and his symptoms improved. This case highlights a rare etiology of chest pain and the first reported case of the association of polycythemia vera and pulmonary vein thrombosis. A high index of suspicion is required for appropriate diagnostic work up. PVT can mimic pulmonary embolism. The diagnostic work up and treatment strategies depend on acuity of presentation.

慢性增殖性血液病假性低血糖10例分析

目的正确判断慢性增殖性血液病导致的低血糖,以指导临床正确治疗。方法对血糖低于2.8mmol.L-1而无任何低血糖症状的7例慢性粒细胞白血病及3例真性红细胞增多症患者,临床上未做任何特殊处理,生化血糖结果回报后同时急查指端血糖,并完善口服葡萄糖耐量试验、C肽释放试验及胰岛素释放试验。结果 10例患者胰岛素、C肽水平均正常,口服葡萄糖耐量试验提示空腹血糖低,但服糖后60、120min血糖均正常;采血后搁置0、30、60、120、180min的血糖值分别为(6.25±0.35)、(95.79±0.46)、(4.78±0.43)、(3.27±0.48)、(1.68±0.54)mmol.L-1,提示血标本搁置时间长可导致血糖检测水平低,证实此10例患者低血糖均为假性低血糖。结论慢性粒细胞白血病及真性红细胞增多症均可以出现假性低血糖,临床上需正确判断,避免盲目治疗。

真性红细胞增多症血瘀证实质研究进展

文章从血液流变学、血小板功能变化、微循环障碍等几方面阐述了血瘀证实质研究进展,并对近年来真红细胞增多症血瘀证实质研究的进展作了总结,认为真红细胞增多症血瘀证,有不同于其他疾病瘀证的特点,但仍可利用现有血瘀证诊断量化指标进行研究探讨。

对比不同静脉放血方法治疗真性红细胞增多症的临床效果

目的:观察四种不同的静脉放血方法治疗真性红细胞增多症的临床疗效,对比分析不同疗法所用的时间及管道填塞率,从而探讨治疗真性红细胞增多症的有效方法。方法:选取2009年5月至2012年5月我院收治的真性红细胞增多症患者50名,随机采取密闭式放血袋法、注射器法、胃肠减压器法和球形负压引流袋法对上述患者进行治疗,观察并比较不同方法治疗的过程中,患者管道的填塞率及操作时间。结果:密闭式放血袋法在放血过程中穿刺成功率高,操作时间短,管道的填塞率低。结论:密闭式放血袋操作简便,省时、省力、无并发症发生,可在临床广泛推广使用。