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An old male patient visited the hospital due to shortness of breath and palpitation for 6 h, with fever 3 days before and pump failure at admission. Having no risk factor of coronary diseases such as hypertension, diabetes mellitus and obesity, with ST-T changes and abnormal Q wave on ECC, the signs were compatible with those of acute anterior wall myocardial infarction, while the characteristics of cardiac biomarkers ( significant increase in Troponin I and creatine kinase's isoform, and normal creatine kinase) were not in accordance with those of acute myocardial infarction. Emergency angiography was performed, which indicated normal coronary artery, normal pulmonary artery and global systolic dysfunction of left ventricle. The diagnosis of acute severe myocarditis was established, and intra-aortic balloon pump (IABP) was employed to provide hemodynamic support. Severe myocarditis mimicking acute myocardial infarction may be fatal, and can be easily misdiagnosed. Careful analysis of clinical manifestations, early diagnostic angiography and possible IABP placement are important for the successful treatment.
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Objective To investigate the effects of tirofiban application time on middle-term clinical prognosis in patients with acute ST segment elevation myocardial infarction (STEMI)treated by primary percutsneous coronary intervention (PCI). Methods The study of tirofiban was carried out in 50 patients with STEM[in cardiology department from January to December 2006. Twenty-nine patients were randomized to receive tirofiban after PCI for 24 - 36 hours(short time group, STG) and 21 patients for 48 - 72 hours (long time group,LTG). Clinical characteristics, angiography data, main adverse cardiovascular events (MACE) and coronary restenosis rate in 6-month follow-up of the two groups were. compared. Results Follow-up data showed that there was less intractable angina pectoris (14.3% vs 24.1%, P< 0.05) in LTG. But there was no significant difference in coronary restenosis rate between two groups. Conclusion Long time application of tirofiban following PCI in patients with STEMI could improve middle-term clinical prognosis by alleviating the incidence of intractable angina pectoris.
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Objective:To investigate the related factors and clinical significance of peritoneal micrometastasis in patients with gastric carcinoma,providing theoretical basis for resection range。Methods:CK19,CK20 immunohistochemistry were performed on 62 patients' tissues taken from anterior lobe of transverse mesocolon,posterior wall of omental bursa,pancreatic capsule and rectovesical pouch or Douglas pouch during the operations,compared with HE staining and peritoneal lavage cytology(PLC).Results:No metastasis was found by HE staining.Peritoneal micrometastasis were found in 27 cases out of 62 by immunohistochemistry,and its positive rate was 43.55%,obviously higher than PLC(14.52%).The peritoneal micrometastasis of gastric carcinoma had relations with diameter of tumor,depth of infiltration,clinical stage,lymph node metastasis(P0.05).Conclusion:Immunohistochemistric measure of CK 19 and CK20 can be effective to detect the micrometastasis of gastric carcinoma,which is helpful to guide clinical staging and useful to provide evidence for accurate selection of operation and postoperative treatment.Routine detection of peritoneal micrometastasis should be taken in patients of advanced gastric carcinoma,especially with a large size of serosa invasion.Multiple spots sampling is helpful to improve the detection rate.Anterior lobe of transverse mesocolon and pancreatic capsule should be peeled,and radical resection of omental bursa should be considered as routine operation in these patients.
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Objective To estimate the value of the Angio seal (Vascular Cloure Device, St Jude Medical) in femoral artery closure after CAG (coronary angiography) or PCI (percutaneous coronary intervention). Methods From Oct 2002 to Oct 2003 316 patients received CAG or PCI at our hospital They were divided into group A (150 patients) and group B (166 patients) The Angio seal was useded in group A to close the puncturing spot of femoral artery, and the side of the body punctured was trigged for 4 hours Common hemostasis was adopted in group B Results As compared with group B, time to hemostasis and time to ambulation were notably decreased and groin hematoma and time to bleeding disposed at the puncture site were markedly reduced in group A Conclusion Safe and effective, the Angio seal may be widely adopted in clinical practice
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Objective To follow up the patients with pacemaker, observe the condition of pacemaker lead, to explore the cause of lead dislocation, to find out and prevent its occurrence.Methods Summarizing the clinical data of 6 patients with pacemaker,7 pacemaker leads with 8 time dislocation,pacemaker 2 DDDR、2 DDD、2 VVI。 Results Four patients were punctured from right subclavian vein、one from left subclavian vein and one from right brachiocephalic vein; four leads were dislocation in atrium and one mildly dislocation; four leads dislocation in ventricle and two mildly dislocation; There were 3 old women with 4 leads and 5 times of dislocation. Conclusions