Research progress in perioperative management of portal vein thrombosis in liver transplantation / 器官移植

Portal vein thrombosis is one of the common complications of liver cirrhosis. The incidence of portal vein thrombosis is increased with the progression of diseases. The incidence and progression of portal vein thrombosis are associated with multiple factors. The indications of anticoagulant therapy remain to be investigated. At present, portal vein thrombosis is no longer considered as a contraindication for liver transplantation. Nevertheless, complicated portal vein thrombosis will increase perioperative risk of liver transplantation. How to restore the blood flow of portal vein system is a challenge for surgical decision-making in clinical practice. Rational preoperative typing, surgical planning and portal vein reconstruction are the keys to ensure favorable long-term prognosis of liver transplant recipients. In this article, epidemiological status, risk factors, typing and identification of portal vein thrombosis, preoperative and intraoperative management of portal vein thrombosis in liver transplantation, and the impact of portal vein thrombosis on the outcomes of liver transplantation were reviewed, aiming to provide reference for perioperative management of portal vein thrombosis throughout liver transplantation.

Analysis of anticoagulant therapy and pharmaceutical care for a patient with obstetrical antiphospholipid syndrome complicated with HELLP syndrome / 药物流行病学杂志

A 37-year-old woman with obstetric antiphospholipid syndrome(OAPS)was admitted to hospital due to poorly controlled hypertensive.After admission,the patient's blood pressure fluctuated greatly(152-161/100-112mmHg),platelet count decreased progressively(65x109·L-1),with lactate dehydrogenase of 367 U·L-1,alanine aminotransferase of 121.8 U·L-1,and aspartate aminotransferase of 89 U·L-1,and the disease progressed to HELLP syndrome.The clinical pharmacists participated in the treatment of this patient,combined the patient's risk of thrombosis and bleeding,changes in platelet count,and pharmacokinetic characteristics of anticoagulant drugs to assist clinicians in formulating the individualized anticoagulant treatment plan in the perinatal period,and promptly stopped and started anticoagulant drugs,which effectively prevented the patient from the occurrence of thrombosis and postpartum hemorrhage complications.Meanwhile,based on evidence-based pharmacology,the clinical pharmacists analyzed the key points of pharmacological care for such patients during pregnancy and lactation.The standardized use of OAPS treatment drugs,such as hydroxychloroquine,aspirin and prednesone,have more advantages than disadvantages during pregnancy,but the corresponding adverse reactions need to be closely monitored.Enoxaparin does not accumulate in milk and can be used safely during lactation.The clinical pharmacists play an important role in guaranteeing the safety and effectiveness of medication for pregnant and lactation patients.

Acute ischemic stroke: management approach

A stroke, or brain attack, happens when blood flow to the brain is stopped. It is an emergency situation. The brain needs a constant supply of oxygen and nutrients in order to work well. If blood supply is stopped even for a short time, this can cause problems. Brain cells begin to die after just a few minutes without blood or oxygen. Stroke is the second most common cause of death worldwide and the most important cause of physical weakness, with a growing occurrence in developing countries. Ischemic stroke is the most common type of stroke which occurs due to arterial block and managed by fast reperfusion with endovascular thrombectomy and intravenous thrombolysis. The first step in stroke management is initial identification of patients with stroke and triage to centers accomplished of transporting the suitable treatment, as fast as conceivable. Mobile stroke units, tele stroke and artificial intelligence are technologies playing an important role in recognizing and treating stroke. Stroke system-of-care models remain to streamline the distribution of definitive revascularization in the age of mechanical thrombectomy. Overall, in the present review, we emphasized the pathophysiology, diagnosis and management of acute ischemic stroke (AIS).

Advances in anticoagulant therapy for cirrhosis combined with atrial fibrillation / 中华肝脏病杂志

Relevant research in recent years has demonstrated that the atrial fibrillation occurrence rate is significantly higher in patients with cirrhosis. The most common indication for long-term anticoagulant therapy is chronic atrial fibrillation. The use of anticoagulant therapy greatly reduces the incidence rate of ischemic stroke. Patients with cirrhosis combined with atrial fibrillation have an elevated risk of bleeding and embolism during anticoagulant therapy due to cirrhotic coagulopathy. At the same time, the liver of such patients will go through varying levels of metabolism and elimination while consuming currently approved anticoagulant drugs, thereby increasing the complexity of anticoagulant therapy. This article summarizes the clinical studies on the risks and benefits of anticoagulant therapy in order to provide a reference for patients with cirrhosis combined with atrial fibrillation.

Thromboembolism Risk and Treatment of Therapeutic Agents for Inflammatory Bowel Disease / 胃肠病学

Patients with inflammatory bowel disease(IBD)have an increased risk of thromboembolism.Recent reports on Janus kinases inhibitors and thromboembolic adverse events have revealed that IBD therapeutic drug play an essential role in modifying this risk in a pro or antithrombotic manner,in addition to the increased risk of thrombosis of IBD itself.In this review,we provide an overview of the current understanding on thrombosis risk,mechanism and anticoagulant therapy of IBD drugs.While controlling the activity of the disease with appropriate therapy,thromboembolism prophylaxis and personalized treatment o should be emphasized.

Clinical characteristics of acute renal infarction: an analysis of 15 cases / 中华全科医师杂志

Clinical data of 15 patients diagnosed with acute renal infarction (ARI) in Affiliated Zhongshan Hospital of Dalian University from Jan 2011 to Dec 2021 were retrospectively analyzed. Of the included 15 patients, there were 14 cases of cardiac origin and 1 case of antiphospholipid syndrome. We found that there were 12 cases of atrial fibrillation, 2 cases of atrial premature beats, 12 cases of elevated level of D-dimer, 15 cases of elevated level of LDH, 11 cases of positive urine occult blood and positive urine protein. Among the 15 patients, catheter-directed thrombolysis was performed in 4 cases, of which 3 cases were revascularized successfully, intravenous thrombolysis in 2 cases and alone anticoagulation therapy in 9 cases. It is suggested that CECT or CTA can assist the early diagnosis of ARI especially in patients with acute onset and persistent abdominal pain with high risk factors of thromboembolism, high levels of LDH, microscopic hematuria and/or proteinuria. Despite prolonged embolic ischemia, try to reconstruct blood flow to save the kidney as much as possible. Late standardized anticoagulant therapy is of critical importance to prevent recurrent embolic episodes.

Clinical and imaging analysis of hypoplastic left atrial appendage / 中国介入心脏病学杂志

Objective This study aims to analyze the clinical and imaging characteristics of atrial fibrillation(AF)patients with left atrial appendage(LAA)hypoplasia and to explore the effectiveness of anticoagulation in preventing left atrial thrombus.Methods A retrospective analysis was conducted on five AF patients with LAA hypoplasia.The patients in this study were diagnosed using left atrial computed tomography venography venography(CTV)and/or transesophageal echocardiography(TEE)out of a total of 3 068 patients who were admitted to Zhoupu hospital between July 2018 and October 2023.The analysis included an examination of clinical features,and imaging data,and anticoagulation treatment was analyzed.Results The study found that out of the 5 patients with LAA hypoplasia,only one patient underwent both left atrial CTV and TEE examinations.One patient underwent chest CT scan and TEE,while the remaining three patients underwent complete left atrial CTV and were all diagnosed with LAA hypoplasia.The diagnosis relied on the delay and venous phase of multiplanar reconstruction of left atrial CTV,while TEE was only able to detect small crevices or no abnormalities.The incidence of LAA hypoplasia was 1.63‰.The characteristics of LAA hypoplasia include a small LAA,thick LAA wall,and LAA without cavity or small.All five AF patients were complicated with cardio-cerebrovascular atherosclerosis,one patient underwent cryoablation,and and antiplatelet or anticoagulant regimen or both therapy strategy was selected.Conclusions LAA hypoplasia is a unique subtype of LAA,that can be diagnosed through multi-plane reconstruction in the delayed and venous phase of left atrial CTV.TEE can serve as a supplementary diagnostic tool,and further research is needed to determine the anticoagulation regimen for AF patients with LAA hypoplasia.

Management of anticoagulant therapy in a patient with complex venous thromboembolism complicated with acute renal insufficiency / 中国药房

OBJECTIVE To provide a reference for the safe use of drugs in patients with complex venous thromboembolism （VTE） and acute renal insufficiency. METHODS Clinical pharmacists participated in the management of anticoagulant therapy for a patient with complex VTE complicated with acute renal insufficiency， and evaluated the patient as high-risk thrombosis and bleeding based on their medical history， laboratory test results， etc.； combined with the complexity of thrombosis and renal insufficiency， clinical pharmacists suggested that enoxaparin sodium should be used in the acute stage of thrombosis （5 to 21 days after onset）， and then warfarin should be adopted for oral anticoagulation treatment. Because the patient’s anticoagulation was not up to the standard （the target range of the international normalized ratio was 2-3）， clinical pharmacists suggested increasing the warfarin dose， detecting the warfarin metabolism genotype， and adjusting the warfarin dose according to the genotype； at the same time， clinical pharmacists developed an anticoagulation monitoring plan to ensure the safety of anticoagulation treatment. RESULTS Doctors had adopted all the recommendations of clinical pharmacists. The patient did not experience adverse events such as bleeding or worsening of thromboembolism during anticoagulation in the hospital. When the anticoagulation met the standards， the patient was allowed to be discharged with medication. CONCLUSIONS By participating in the anticoagulation treatment management of patients with complex VTE and acute renal insufficiency， clinical pharmacists have assisted doctors in formulating personalized anticoagulation plans to promote the compliance with the anticoagulation treatment standard and ensure the safety and effectiveness of medication for patients.

Compliance of oral anticoagulant medication and influencing factors among nonvalvular atrial fibrillation patients with new-onset acute ischemic stroke / 中华全科医师杂志

Objective:To investigate the compliance of oral anticoagulant(OAC) medication and influencing factors among nonvalvular atrial fibrillation(NVAF) patients with new-onset acute ischemic stroke (AIS).Methods:A total of 396 NVAF patients, who initiated OAC therapy after a new-onset AIS from August 2011 to December 2020 were enrolled from China Atrial Fibrillation Registry (China-AF). The demographic characteristics, medical history, comorbid diseases and medication of patients were collected before and after the index stroke, and the influencing factors of compliance of OAC medication were analyzed.Results:Patients were followed up for a mean of 26.9 months. Among 396 patients, 228 (57.6%) had continuous anticoagulant medication (persistent OAC group);while 168 (42.4%) discontinued OAC therapy within 2 years after the index stroke (non-persistent OAC group). Patients on persistence OAC had a higher proportion of atrial fibrillation episodes than patients on non-persistent OAC [83.3% (190/228) vs. 73.8% (126/168); χ 2=5.34, P=0.021], while lower proportion of radiofrequency ablation(RFA)[18.9% (43/228) vs. 32.1% (43/228); χ 2=9.22, P=0.002]. Multivariate Cox regression modelshowed that history of RFA ( HR=1.77, 95% CI: 1.25-2.50; P=0.001) was positively associated with non-persistence of OAC. Conclusion:The study indicates that quite large proportion of NVAD patients with a new-onset of AIS discontinued OAC therapy during 2 years of follow up, and a history of RFA procedure might be an independent factor associated with discontinuing of anticoagulant therapy.

Exploration and practice of information-based pharmaceutical care pathway of anticoagulant therapy in patients with atrial fibrillation / 中国药房

OBJECTIV E To develop the infor mation-based pharmaceutical care pathway of anticoagulant therapy in patients with atrial fibrillation and improve the efficacy and safety of treatment for them. METHODS The“anticoagulant pharmaceutical care”module was developed on the basis of medical intelligent and decision system. Patients with atrial fibrillation were taken pharmaceutical care in the whole anticoagulant treatment by evaluating the thromboembolism and bleeding risks ，pre-reviewing antithrombotic prescriptions ，monitoring efficacy and drug interactions ，and warning adverse reactions. RESULTS A total of 1 228 patients receiving anticoagulant therapy were enrolled. It was found after analysis of their doctor ’s orders that 9.27％ of the patients adjusted the improper antithrombotic therapies ，3.99％ modulated treatments according to the effects of potential drug interactions or the risk of adverse reactions ，and 70.29％ of the wrong prescriptions were intervened successfully. After the information-based pharmaceutical care ，the anticoagulation treatment rate increased from 88.73％ to 97.40％，the rate of patients ’achievements to warfarin’s international normalized ratio in hospital increased from 38.64％ to 66.67％，and the incidence of serious bleeding events decreased from 2.94％ to 0.37％ （P＜0.05）. CONCLUSIONS The information-based pharmaceutical care path of anticoagulant therapy achieved comprehensive ，efficient and accurate management of patients with atrial fibrillation ，and improved the rationality ，effectiveness and safety of anticoagulant therapy.

Diagnosis and treatment of vascular complications after liver transplantation in adults / 器官移植

As an efficacious treatment for end-stage liver diseases and primary malignant liver tumors, liver transplantation has been widely applied worldwide, and gradually receives widespread recognition from patients. With the development of organ transplant technique, vascular complications have rarely occurred after adult liver transplantation. However, vascular complications, such as postoperative thrombosis and anastomotic stenosis, are still common in the recipients undergoing living donor liver transplantation and split liver transplantation. Inappropriate treatment may lead to the loss of grafts and death of recipients. The authors have been engaged in liver transplantation for many years, witnessing persistent development of diagnostic and therapeutic technologies for vascular complications after liver transplantation. In this article, current status and development trend of diagnosis and treatment of different vascular complications were illustrated from the etiology, clinical manifestations, diagnosis and treatment of hepatic artery complications, portal vein complications, inferior vena cava and hepatic vein complications, aiming to further improve the survival rate of grafts and recipients and provide reference for promoting the development of clinical liver transplantation.

Preliminary clinical experiences of hepatic sinusoidal obstruction syndrome after orthotopic liver transplantation / 中华器官移植杂志

Objective:To explore the etiology, pathogenesis, clinical features, diagnosis and treatment of hepatic sinus obstruction syndrome(HSOS)after orthotopic liver transplantation(OLT).Methods:Clinical data were reviewed for 3 HSOS patients after OLT.Baseline profiles, primary disease, onset, clinical manifestations, abdominal imaging and pathological changes were recorded for summarizing the key points of diagnosis, treatment and outcomes of HSOS after OLT.Results:HSOS was an extremely rare complication after OLT with an incidence of 2%(2/117)and a median onset of 15(13-50)days.The major clinical manifestations were hepatic pain, abdominal distension, poor appetite, fatigue, jaundice, oliguria, peritoneal effusion and pleural effusion.Some of them were complicated with acute renal insufficiency.Abdominal ultrasonography revealed that blood stream of hepatic and portal veins was smooth but rather slow and hepatic parenchyma showed uneven echo changes.Abdominal enhanced computed tomography(CT)demonstrated " mosaic" and " map-like" uneven enhancement in portal vein and balance phases.The pathological manifestations of liver biopsy included obvious dilation and congestion of hepatic sinuses, swelling and necrosis of hepatic cells, thickening of hepatic venules and luminal stenosis or occlusion.All of them received immunosuppressants.Tacrolimus was switched to sirolimus, low molecular weight heparin or plus rivaroxaban anticoagulant thrombolytic therapy, methylprednisolone regulatory immunotherapy, albumin supplementation, diuresis, hepatic protection and fluid replacement.Afterward clinical symptoms of 2 patients improved, became cured and discharged.One case died from gastrointestinal hemorrhage and acute renal failure secondary to multiple organ failure.Conclusions:HSOS is an extremely rare but severe complication after OLT.Early diagnosis and fine-tuning of treatment protocols can avoid poor prognosis such as liver and kidney failure and significantly improve patient survival.

Potential drug-drug interactions among patients with spontaneous intracerebral hemorrhage treated at the Neurological Intensive Care Unit: a single-center experience

Abstract Our aim was to determine the prevalence of potential drug-drug interactions (pDDIs) and to identify relevant factors associated with the occurrence of the most dangerous or contraindicated pDDIs (pCDDIs) in hospitalized patients with spontaneous intracerebral hemorrhage (sICH). A retrospective cross-sectional study was performed enrolling all consecutive patients with sICH treated at the Neurological Intensive Care Unit, Clinical Center in Kragujevac, Serbia, during the three-year period (2012-2014). The inclusion criteria encompassed patients aged 18 years and over, those diagnosed with ICH, and those prescribed at least two drugs during hospitalization, while we did not include patients whose hospitalization lasted less than 7 days, those who were diagnosed with other neurological diseases and patients with incomplete medical files. For each day of hospitalization, the online checker Micromedex® software was used to identify pDDIs and classify them according to severity. A total of 110 participants were analysed. A high prevalence of pDDIs (98.2%) was observed. The median number of pDDIs regardless of severity, was 8.00 (IQR 4.75-13.00;1-30). The pairs of drugs involving cardiovascular medicines were the most commonly identified pDDIs. Twenty percent of the total number of participants was exposed to pCDDIs. The use of multiple drugs from different pharmacological-chemical subgroups and the prescribing of anticoagulant therapy significantly increase the chance of pCDDI (aOR with 95% CI 1.19 (1.05-1.35) and 7.40 (1.13-48.96), respectively). This study indicates a high prevalence of pDDIs and pCDDIs in patients with sICH. The use of anticoagulant therapy appears to be the only modifiable clinically relevant predictor of pCDDIs.

Anestesia regional en la paciente embarazada antiagregada o anticoagulada / Regional anesthesia in the antiplatelet or anticoagulated pregnant patient / Anestesia regional em paciente grávida antiplaquetária ou anticoagulada

Resumen: La anestesia regional es la técnica de elección debida a la menor morbimortalidad. Una de las complicaciones más temidas es el hematoma espinal, teniendo las pacientes que reciben antiagregantes y/o anticoagulantes mayor riesgo de desarrollarlo. El cuadro clínico es variable, y no siempre están todos los elementos presentes (dolor lumbar, déficit motor y/o sensitivo y/o vesical). El diagnóstico se realiza por resonancia nuclear magnética y el tratamiento es la descompresión por laminectomía. Estando el pronóstico neurológico vinculado al tiempo en que se realiza ésta. Se realiza una revisión sobre los distintos fármacos antiagregantes y anticoagulantes utilizados en el embarazo - puerperio y las recomendaciones necesarias para las pacientes que recibirán una anestesia regional.

Abstract: Regional anesthesia is the technique of choice due to lower morbidity and mortality. One of the most feared complications is spinal hematoma, with patients receiving antiplatelet and / or anticoagulants having a greater risk of developing it. The clinical picture is variable, and not all the elements are always present (lumbar pain, motor and / or sensory and / or bladder deficits). Diagnosis is made by magnetic resonance imaging and treatment is laminectomy decompression. Being the neurological prognosis linked to the time in which it is performed. A review is made of the different antiplatelet and anticoagulant drugs used in pregnancy - puerperium and the necessary recommendations for patients who will receive regional anesthesia.

Resumo: A anestesia regional é a técnica de escolha devido à menor morbimortalidade. Uma das complicações mais temidas é o hematoma espinhal, com pacientes em uso de antiagregantes plaquetários e / ou anticoagulantes com maior risco de desenvolvê-lo. O quadro clínico é variável e nem sempre os elementos estão presentes (dor lombar, déficits motores e / ou sensoriais e / ou vesicais). O diagnóstico é feito por ressonância magnética e o tratamento é a descompressão por laminectomia. Sendo o prognóstico neurológico ligado ao tempo em que é realizado. É feita uma revisão das diferentes drogas antiplaquetárias e anticoagulantes utilizadas na gravidez - puerpério e as recomendações necessárias para as pacientes que receberão anestesia regional.

Significance and future of anticoagulant therapy for sepsis / 中华危重病急救医学

Sepsis is caused by the imbalance of the host body's response to infection, which causes life-threatening organ dysfunction. Disorders of blood coagulation play a very important role in the development of sepsis. In sepsis, the body's coagulation system is activated, leading to hypercoagulability, while the anticoagulation mechanism is significantly inhibited, causing a large number of microthrombi to form, and disseminated intravascular coagulation (DIC) may occur. Although there are obvious controversies about the anticoagulation treatment of sepsis at home and abroad, we cannot deny the significance of anticoagulation treatment in sepsis. Only appropriate anticoagulation can effectively reduce the mortality in septic DIC, septic shock and high-risk population, and ultimately effectively reduce the occurrence of multiple organ dysfunction syndrome. The sepsis-induced coagulation dysfunction (SIC) score is currently used internationally to guide anticoagulation. SIC score is optimized based on the International Society on Thrombosis and Haemostasis (ISTH) overt DIC score and Sepsis-3, including platelet, international normalized ratio (INR) and sequential organ failure assessment (SOFA). The SIC score can sensitively monitor sepsis-induced coagulation dysfunction. When the SIC score is≥4, it is the best timing to initiate anticoagulation therapy. At present, the internationally recommended anticoagulant drugs include antithrombin (AT), thrombomodulin (TM), tissue factor pathway inhibitor (TFPI), heparin, etc., while the domestically recommended anticoagulant drugs are only unfractionated heparin and low molecular weight heparin. Before using anticoagulant drugs, it is necessary to evaluate the possibility of bleeding and thrombosis in the patients. At the same time, it is necessary to pay attention to the patient's primary disease. Try to adopt the treatment strategy of transitioning from unfractionated heparin to low molecular weight heparin without obvious anticoagulation contraindications.

Study on warfarin dose adjustment strategy at different stages after mechanical valve replacement of mitral valve / 中国胸心血管外科临床杂志

@#Objective    To explore the anticoagulant strategy of adjusting the dose of warfarin at different stages after mechanical valve replacement of mitral valve. Methods    Clinical data of a total of 302 patients, including 76 males and 226 females, with an average age of 50.1±10.1 years, who underwent mechanical mitral valve replacement in the Chinese adult cardiac surgery database from 2013 to 2017 were retrospectively analyzed. According to the dose adjustment strategy of taking warfarin, the patients were divided into a D group (adjusting warfarin dose in days) and a W group (adjusting warfarin dose in weeks) to evaluate the anti-coagulation effect of warfarin. Results    The total follow-up time was 423 277 d (1 159.7 years). There was no significant difference in the overall anticoagulant strength, and the warfarin dose adjusted in days was better in the early postoperative period (P<0.05), especially in patients over 60 years. It was better to adjust warfarin dose in weeks in the middle and long periods (P<0.05), especially in patients ≤40 years. In terms of the stability of anticoagulation, it was better to adjust the dosage of warfarin in weeks (P<0.05). It was better to adjust the dosage of warfarin in weeks for early, middle- and long-term anticoagulant therapy after operation (P<0.05), especially in the females aged >40 and ≤50 years. Conclusion    Within the target range of international normalized ratio (1.5-2.5), the anticoagulant strategy of adjusting warfarin dose in days after mechanical valve replacement of mitral valve can   achieve a better anticoagulant strength, and adjusting the dosage of warfarin in weeks is better in the middle- and long-term after operation. In general, the anticoagulant effect is more stable in the short term when warfarin dose is adjusted on a weekly basis.

Analysis of risk factors and clinical prognosis of massive blood transfusion during perioperative period of lung transplantation / 器官移植

Objective To investigate the risk factors and clinical prognosis of massive blood transfusion during the perioperative period of lung transplantation. Methods Clinical data of 159 lung transplant recipients were retrospectively analyzed. According to the quantity of perioperative blood transfusion, all recipients were divided into the massive blood transfusion group (n=20) and non-massive blood transfusion group (n=139). Clinical data of lung transplant recipients were statistically compared between two groups. The risk factors of perioperative massive blood transfusion were analyzed. Clinical prognosis of the recipients was observed in two groups. Results There were significant differences between the two groups in preoperative data including anticoagulant therapy, hemoglobin content, the number of recipents with idiopathic pulmonary fibrosis or idiopathic pulmonary hypertension, and intraoperative data including the number of recipents presenting with intraoperative intrathoracic adhesion, operation time and the amount of various component transfusion(all P < 0.05). Preoperative anticoagulant therapy, incidence of intraoperative intrathoracic adhesion, use of extracorporeal membrane oxygenation (ECMO) and long operation time were the risk factors of massive blood transfusion during perioperative period of lung transplantation(all P < 0.05). In the massive blood transfusion group, the incidence rate of grade Ⅲ primary graft dysfunction (PGD) and the fatality within postoperative 30 d were higher compared with those in the non-massive blood transfusion group(both P < 0.01). Low body mass index (BMI) and massive blood transfusion were the risk factors for death within postoperative 30 d(P=0.048、P < 0.001). The 1-year survival rate in the massive blood transfusion group was lower than that in the non-massive blood transfusion group(P < 0.001). Conclusions Preoperative anticoagulant therapy, incidence of intraoperative intrathoracic adhesion, use of ECMO and long operation time are the risk factors for massive blood transfusion during perioperative period of lung transplantation. Massive blood transfusion negatively affects the clinical prognosis of the recipients undergoing lung transplantation.

A Mobile Thrombus in the Aortic Arch / 日本心臓血管外科学会雑誌

A 51-year-old man was referred to our hospital with pain and coldness of the upper left extremity. Contrasted computed tomography revealed a silhouette protruding into the aortic arch. Peripheral embolism in upper left extremity by tumor or thrombosis was suspected. Magnetic resonance imaging revealed a mobile mass in the aortic arch. To prevent recurrent embolization, the mass and the aortic arch to which the mass was attached were excised and partial arch replacement was performed under cardiopulmonary bypass. Histologically, the mass was a fibrin thrombus with no malignancy. The aortic wall showed only mild atherosclerosis of the intima. No thrombotic predisposition such as protein S or C deficiency or antiphospholipid antibody syndrome was observed. Anticoagulant therapy was started and the patient was discharged on postoperative day 10 without recurrent thromboembolism. Three years have passed since the operation and there is no recurrence of thromboembolism.

Diagnosis and treatment of hepatic sinusoidal obstruction syndrome after liver transplantation: a single-center experience / 器官移植

Objective To summarize the incidence, diagnostic and therapeutic experience of hepatic sinusoidal obstruction syndrome (HSOS) after liver transplantation. Methods Clinical data of 4 patients with HSOS after liver transplantation were retrospectively analyzed. The incidence, clinical manifestations, imaging and pathological characteristics of HSOS after liver transplantation were collected, and the treatment methods and clinical outcomes of patients with HSOS were analyzed. Results The incidence of HSOS after liver transplantation was 0.8%(2/239), and the median time of onset was 4.5(1.7, 9.0) months after liver transplantation. The clinical manifestations of HSOS mainly included abdominal distension, ascites, hepatomegaly, increased bilirubin, and renal insufficiency in partial cases. Enhanced abdominal CT scan of 4 patients with HSOS showed uneven spot-like enhancement and the liver histopathological examination mainly showed the signs of hepatic sinusoidal dilatation complicated with congestion. Four patients were administered with an adjusted regime of immunosuppressant by replacing tacrolimus (Tac) with ciclosporin and adding anticoagulant therapy with warfarin. One patient received transjugular intrahepatic portosystemic shunt (TIPS). After treatment, the symptoms of 3 patients were completely relieved, and 1 patient died. One of the 3 surviving patients died from pulmonary infection and gastrointestinal bleeding. Conclusions HSOS is a rare and fatal complication after liver transplantation. Timely diagnosis and treatment can avoid the incidence of graft failure and improve clinical prognosis of the patients.

Clinical characteristics and therapeutic efficacy of spontaneous intracranial hypotension complicated with cerebral venous thrombosis: an analysis of four cases / 中华神经医学杂志

Objective:To investigate the clinical characteristics and therapeutic efficacy of spontaneous intracranial hypotension (SIH) complicated with cerebral venous thrombosis (CVT).Methods:The clinical data of 4 patients with SIH complicated with CVT admitted to our hospital from March 2014 to April 2020 were retrospectively analyzed. And the clinical data of 35 patients with SIH complicated with CVT were included for summary analysis through literature retrieval (the databases included PubMed, CNKI and Wanfang; retrieval period was from database construction to December 31, 2020).Results:These 4 patients were with onset of orthostatic headache; one was with recurred orthostatic headache after relief, and the other 3 developed persistent headache and epileptic seizure; case 1 was with superior sagittal sinus and cortical vein thrombosis, case 3 was with superior sagittal sinus thrombosis, and other 2 patients were with isolated cortical vein thrombosis. Twenty-six documented cases demonstrated headache changes: 12 patients (46.15%) developed persistent headache, 12 patients (46.15%) showed orthostatic headache persistently, and 2 patients (7.69%) had disappeared headache. The most common new symptoms were epilepsy in 17 patients (48.57%) and limb weakness in 10 patients (28.57%). Totally, these 31 patients (4 patients from our hospital+27 patients from literature retrieval) had hemorrhage after treatment; the percentage of patients having hemorrhage changes in the 17 patients accepted anticoagulant therapy was significantly increased as compared with that in 14 patients accepted other treatments (7/17 vs. 1/14, P<0.05); there were no bleeding changes in 5 patients accepted epidural blood patch and anticoagulant therapy. Conclusions:The clinical features of SIH complicated with CVT are various, and the change of headache is not a reliable marker. In the course of SIH, it is necessary to be alert to the occurrence of CVT if there are new symptoms such as epileptic attack or limb weakness. The etiological treatment of SIH is essential and the hemorrhage risk after anticoagulant therapy should be concerned in patients with SIH complicated with CVT.