west china medical publishers
Author
  • Title
  • Author
  • Keyword
  • Abstract
Advance search
Advance search

Search

find Author "唐昊" 11 results
  • Severe pneumonia caused by Chlamydia psittaci in an immuno-compromised patient: a case report and literature review

    Objective To investigate the clinical manifestations, diagnosis, treatment and prognosis of psittacosis patients. Methods The clinical features, treatment and prognosis of severe pneumonia caused by Chlamydia psittaci were analyzed and relevant literatures were reviewed. Results An 83-year-old male with a history of type 2 diabetes mellitus was admitted to the hospital for "fever, cough for 5 days and dyspnea for 3 days". Chest CT showed a large mass of increased density in the right lung; CD4+ T lymphocytes had an absolute value of 23 cells/μL; Blood gas analysis showed type Ⅰ respiratory failure; Chlamydia psittaci was detected by metagenomic next-generation sequencing. The patient was diagnosed of severe pneumonia (Chlamydia psittaci), type 2 diabetes mellitus, suspected central nervous system infection. This patient was treated with doxycycline and macrolides antibiotics and discharged from hospital after complete recovery. Literature review showed that patients got infected from contacting sick bird, manifested with multiple system involvement. Respiratory symptoms were common, while central nervous system infection seemed to be rare. The diagnosis of psittacosis depended on serology, nucleic acid detection, pathogen isolation and culture. Metagenomic next-generation sequencing had superiority in the diagnosis of psittacosis. Tetracyclines were the preferable treatment, such as doxycycline or tetracycline, with a duration of at least 10 to 14 days. The prognosis of psittacosis was well, and most of the severe and even life-threatening cases were caused by unclear diagnosis and delayed treatment, and the overall mortality rate was about 1%. Conclusions Psittacosis is one kind of zoonoses. History of poultry exposure is helpful in diagnosis, and metagenomic next-generation sequencing has advantages in diagnosing psittacosis. Tetracyclines are preferred with adequate course of treatment. The overall prognosis is good.

    Release date: Export PDF Favorites Scan
  • 抗菌药物耐药机制和抗感染治疗研究进展

    目前临床应用的抗菌药物大部分是在1936~1968年间发现的,过去的40余年仅发现了3种具有新型抗菌作用机制的药物,即利奈唑胺、达托霉素和Mutilins。有限的抗菌药物资源和抗菌药物滥用使得细菌迅速获得耐药性,细菌对抗菌药物的耐药性已成为全球性问题,给抗感染治疗带来了严峻挑战,NDM-1耐药基因的出现更是雪上加霜。今年世界卫生日的主题为“抵御耐药性:今天不采取行动,明天就无药可用”,世界卫生组织号召所有主要利益相关方,包括决策者和计划者、公众和患者、行医者和处方者、药剂师和药物供应商以及制药业,采取行动并负起责任,抵御抗菌药物耐药性。近年来,抗菌药物耐药机制的研究揭示了新型耐药机制,同时,新药物、新的致病机制和治疗手段的发现为抵御耐药菌感染打下了坚实的理论基础。本文拟就这两方面内容做一综述。

    Release date:2016-08-30 11:58 Export PDF Favorites Scan
  • Methods and Results of Supra-annular Aortic Valve Replacement for Patients with Severely Damaged Aortic Annulus

    Abstract: Objective To summarize the methods and results of supra-annular aortic valve replacement(AVR) in patients with severely damaged aortic annulus. Methods Supra-annular AVR was performed in 5 patients between March 2008 and Dec. 2010 in Changhai Hospital, Second Military Medical University. There were 4 males and 1 female with their mean age of 46.3 years (ranging from 38 to 53 years). Non-specific infectious diseases were diagnosed in 4 patients who had severe paravalvular leakage after their first AVR operations (2 patients with Behcet’s disease and 2 patients with arteritis), and one patient had severe infectious endocarditis. All the patients had severely destroyed aortic annulus and could not undergo routine AVR. The prosthetic valves were fixed to the aortic sinus wall between the annulus and coronary arterial ostia, and the sutures passed through from the outside of aortic wall into the inside and prosthetic valve ring. Coronary artery bypass grafting was performed if the coronary ostium was involved. Results All patients recovered from the operations uneventfully, and were followed up from 6 months to 3 years. All patients were in New York Heart Association(NYHA) functional class Ⅰ or Ⅱ during the follow-up period, and paravalvalar leakage, pseudoaneurysm and aortic root aneurysm were not found by the examination of 3D computed tomographic angiography and echocardiography at 6 months(4 cases), 1 year(2 cases), and 3 years(1 case), respectively . Conclusions Supra-annular AVR is an alternative surgical method for patients with severely damaged aortic annulus. The procedure is simple and effective to prevent paravalvular leakage and pseudoaneurysm formation.

    Release date:2016-08-30 05:48 Export PDF Favorites Scan
  • Ring Annuloplasty Using Prosthetic Vascular Graft for the Treatment of Tricuspid Regurgitation:Experience in 56 Patients.

    Abstract: Objective To evaluate the surgical effect of ring annuloplasty using prosthetic vascular graft for the treatment of tricuspid regurgitation. Methods From July 2000 to July 2010, ring annuloplasty using prosthetic vascular graft was performed to a total of 56 patients with tricuspid regurgitation in Changhai Hospital of Second Military Medical University. There were 24 male patients and 32 female patients. Their mean age was(45.7±21.8)years (ranging from 14 to 73 years). All the patients were diagnosed as moderate to severe tricuspid regurgitation by color Doppler echocardiography examination, including 47 patients with rheumatic heart valve diseases, and 9 patients with congenital heart disease (Ebstein’s anomaly). All the 56 patients underwent ring annuloplasty using prosthetic vascular graft instead of Carpentier annuloplasty ring for the treatment of tricuspid regurgitation. Results There was no in-hospital death. Postoperatively, one patient had acute respiratory failure, one patient had acute kidney failure, and one patient had re-exploration for bleeding. All patients had none or mild tricuspid regurgitation by echocardiography examination one month after surgery. Forty eight patients were followed up from 1.0 to 9.5 years with a median follow-up time of 3.8 years. During follow-up, there was no late death, but one patient had brain embolism as an anticoagulation complication. Sixteen patients were in New York Heart Association (NYHA) functional classⅠ, 26 patients in NYHA classⅡ, and 6 patients in NYHA class Ⅲ. Thirty six patients had no tricuspid regurgitation, 10 patients had mild tricuspid regurgitation, and 2 patients had moderate tricuspid regurgitation by echocardiography examination during follow-up. Conclusion The early and mid-term follow-up results of ring annuloplasty using prosthetic vascular graft instead of Carpentier annuloplasty ring for the treatment of tricuspid regurgitation are satisfactory. It is a good choice for the surgical treatment of tricuspid regurgitation.

    Release date:2016-08-30 05:49 Export PDF Favorites Scan
  • 二尖瓣置换术后左心室破裂的防治方法

    摘要: 目的 探讨二尖瓣置换术后发生左心室破裂的预防及处理方法,总结治疗经验。 方法 1998年1月至2007年12月第二军医大学长海医院救治7例二尖瓣置换术后发生左心室破裂患者,男2例,女5例;年龄49~72岁(60.0±8.4岁)。术中发生左心室破裂3例,其中1例予以心外修补,2例予以心内、心外联合修补;术后发生左心室破裂4例,立即床旁开胸,在ICU内行心外修补2例;重返手术室1例;放弃救治1例。 结果 围术期死亡5例(71.43%),其中1例术后发生低心排血量综合征和肾功能衰竭,术后3 d死亡;术后发生左心室破裂的3例均未抢救成功而死亡,另1例放弃救治死亡。生存的2例患者采用主动脉内球囊反搏分别支持6 d和8 d,出院前超声心动图提示:左室后壁运动幅度减小。随访2例,随访时间分别为2年和6年,均生存,心功能Ⅰ~Ⅱ级,无假性室壁瘤形成。 结论  左心室破裂的预防至关重要,应在体外循环心脏停搏下修复裂口,术后主动脉内球囊反搏支持有助于提高救治的成功率。

    Release date: Export PDF Favorites Scan
  • 经右胸前外侧切口径路行再次三尖瓣手术的技术改良

    目的 [HTSS]探讨经右胸前外侧切口径路行再次三尖瓣手术的手术技术改良方法,以提高手术疗效。 方法 1997年1月至2009年6月,第二军医大学长海医院对32例左心瓣膜置换术后重度三尖瓣关闭不全患者经右胸前外侧切口径路行再次三尖瓣手术,其中男23例,女9例;年龄43~62岁 (49.5±8.7岁)。行三尖瓣置换术29例,三尖瓣成形术3例。手术中均不做心包粘连分解或上、下腔静脉套带;上腔静脉采用带气囊直插管;下腔静脉仅做引流而不阻断;三尖瓣置换的人工瓣膜置于冠状静脉窦口下方。 结果 手术时间152±38 min,体外循环时间45±13 min;术中出血量272±59 ml;术后24 h胸腔引流量420±93 ml 。术后早期死亡4例(12.5%),其中死于肾功能不全1例,呼吸功能不全2例,多器官功能衰竭1例。随访28例,随访时间3~152个月,随访期间死亡3例,生存患者心功能分级(NYHA)Ⅰ级11例,Ⅱ级13例,Ⅲ级1例。 结论 再次三尖瓣手术的改良技术简化了操作、减少出血、缩短了手术时间。

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • 胸骨上段小切口主动脉瓣置换术11例

    目的 总结经胸骨上段小切口行主动脉瓣置换术的临床经验。方法 11例单纯主动脉瓣病变患者采用胸骨上段上切口,部分劈开胸骨,在全身麻醉体外循环下行主动脉瓣置换术。结果 全组无手术死亡。开放循环后心脏自动复跳9例,除颤复跳2例;所有患者均顺利脱离体外循环,体外循环时间30-102min。术后呼吸机辅助呼吸时间4-12h。无二次开胸止血和切口感染,切口均为1期愈。术后随访11例,随访时间6个月-2年,均无明显的临床症状,主动脉机械瓣膜功能良好,1例患者出现切口疤痕轻度增生。结论 胸骨上段小切口径路可以很好地显露左心室流出道,主动脉瓣和升主动脉,可实施任何单纯主动脉瓣手术,且效果满意。

    Release date:2016-08-30 06:18 Export PDF Favorites Scan
  • 肉芽肿性多血管炎致中枢性尿崩症一例并文献复习

    目的探讨肉芽肿性多血管炎累及垂体的临床表现、影像学特点、治疗及预后。方法对 1 例确诊的肉芽肿性多血管炎致中枢性尿崩症患者的临床资料结合文献复习进行分析,总结其临床特点、治疗及预后。结果本例患者为女性,66 岁,以耳、鼻受损为首发症状,合并肺部、肾脏病变,垂体受累表现为中枢性尿崩症及垂体后叶高信号消失,糖皮质激素诱导治疗后尿崩症缓解。结合文献复习,肉芽肿性多血管炎是最常出现垂体病变的血管炎类型,发病率 1% 左右,好发于女性,多数表现为中枢性尿崩症,其次是腺垂体功能减退、高泌乳素血症。典型的垂体磁共振成像病变征象为 T1 加权相上垂体后叶高信号消失。既往多采用糖皮质激素联合环磷酰胺的诱导缓解方案,但因治疗不及时多数患者不能恢复正常垂体功能。结论肉芽肿性多血管炎累及垂体的情况极为罕见且起病隐匿。尿崩症通常为首发症状或与耳鼻喉症状伴行,肺、肾脏受累症状轻、出现迟。早期诊断和及时治疗有利于减少垂体的不可逆损伤,保存正常垂体功能。

    Release date:2020-01-15 11:30 Export PDF Favorites Scan
  • 先天性心脏病合并肺动脉瓣感染性心内膜炎的外科治疗

    目的 探讨先天性心脏病合并肺动脉瓣感染性心内膜炎的外科治疗方法和效果。 方法 2009年1月至2012年1月第二军医大学长海医院收治先天性心脏病合并肺动脉瓣感染性心内膜炎患者6例,男1例,女5例;年龄8~41 (24.8±11.8)岁。动脉导管未闭(PDA)4例,PDA合并先天性主动脉瓣狭窄1例,室间隔缺损(VSD)合并三尖瓣反流1例。3例行PDA结扎+肺动脉内赘生物清除术,1例行PDA结扎+肺动脉瓣赘生物切除术,1例行PDA结扎+肺动脉瓣赘生物切除术+主动脉瓣置换术(AVR,置换19 mm CarboMetics环上机械主动脉瓣),1例肺动脉瓣膜破坏严重,行VSD修补+右心室流出道赘生物清除+右心室流出道拓宽+三尖瓣成形术+肺动脉生物瓣置换术(置换27 mm HancockⅡ型生物瓣)。 结果 6例患者术后均恢复良好,无围术期死亡和心内膜炎复发。所有患者复查超声心动图提示,未见赘生物、残余漏、瓣周漏等并发症。术后随访6个月~3年中,患者临床症状完全消失,均无明显不适。术后心功能恢复至Ⅰ级5例,Ⅱ级1例。 结论 对于先天性心脏病合并肺动脉瓣感染性心内膜炎患者,正确把握手术时机,积极行外科手术治疗是最有效的治疗方法。

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • Reason Analysis and Prevention of Late Bioprosthetic Heart Valve Thrombosis

    ObjectiveTo analyze the reason and prevention of late bioprosthetic heart valve thrombosis (LBVT). MethodsBioprosthetic heart valves were implanted in 580 patients between January 2001 and July 2013 in Changhai Hospital, and only found one case of LBVT (0.2%). Reoperation was performed for a 67-year-old male patient 3 years after bioprosthetic aortic valve replacement due to severe aortic valve stenosis. Retrospectively analyzed the clinical data and reviewed the literature between January 1989 and December 2013 in Pubmed. ResultsNo risk factor for thrombosis was revealed in this patient. Pathology revealed valve thrombosis and collagen and elastic fibers fragmentation and disruption in valve leaflets. In literature review, 20 articles and 47 cases were brought in. The morbidity of LBVT was 0.2%-1.0%. At least 18 patients had high risk factors, and 15 of the 18 patients discontinued anticoagulation after 3 months. However, at least 10 patients had no high risk factors. Forty-four of the 47 patients received stented porcine valve replacement, only one patient received stented bovine pericardial valve replacement. ConclusionsLBVT is a rare but serious complication after bioprosthetic valve replacement, the causes of which include the feature of the patients and the bioprosthetic valves. Bovine pericardial valves could be superior to porcine valves in preventing LBVT. Postoperative long-time aspirin therapy is recommended for patients without high risk factors. Patients with any high risk factors should prolong anticoagulation.

    Release date: Export PDF Favorites Scan
2 pages Previous 1 2 Next

Format

Content