Objective To explore the diagnosis and treatment of ruptured abdominal aortic aneurysm (RAAA). Methods Between January 1996 and December 2009, 14 patients with RAAA were treated. There were 13 males and 1 female with an average age of 65 years (range, 50-82 years). The main cl inical manifestations were abdominal pain and/or back pain. Ten cases had low blood pressure or shock. All cases were accurately diagnosed with CT, Doppler ultrasonography,or operation. The aneurysm diameter was from 4.5 cm to 8.0 cm. Eleven cases were treated by conventional operation, 1 by endovascular aortic repair, 1 by conservative treatment, and 1 case died after admission treatment. Results Perioperative death occurred in 6 cases (mortal ity rate was 50%) in 12 surgical patients. One case died after conservative treatment. The overall mortal ity rate was 57.14% (8/14). The causes of death included circulatory failure in 2 cases and multiple organ failure in 4 cases. The other 6 cases were cured. The postoperative hospital ization days were 12 to 34 days (14 days on average). A total of 4 cases were followed up 11 to 40 months without related compl ication. Conclusion Surgical treatment is still a main method to treat RAAA. Early diagnosis, appropriate resuscitation, and urgent surgical repair are crucial to reduce the mortal ity rate of RAAA.
Objective To verify the significance of the morphological changes of the macula and its relationship to visual function by using optical coherence tomography (OCT) after scleral buckling procdure. Methods The macula of retinae of 68 patients (70 eyes) with reattached retinae after scleral buckling operation for retinal detachment were examined by OCT to scan the macula through fovea vertically and horizontally. Results Among the 70 eyes, 22 eyes revealed normal macula with thickness of neurosensory retina meant (146.47±20.59)μm. In the other 48 eyes (68.60%) with abnormal macula, 19 eyes showed extensive subretinal interspace, 9 eyes showed local subretinal interspace, 8 eyes showed macula edema, 4 eyes showed thin macula, 4 eyes showed subretinal proliferation and 4 eye showed epiretinal membrane over macula. In the normal macular structure group under the OCT, the visual acuity (VA) of the operated eyes was more than 0.3 in 6 eyes 2 weeks after operation and in 14 eyes 3 mons after operation. In the macula edema group, the VA was more than 0.3 in 1 eye 2 weeks after opoeration and 2 eyes 3 mons after operation. In the subretinal interspace group, the VA was more than 0.3 in 5 eyes 2 weeks after operation and in 23 eyes 3 mons after operation. The proportions of the numbers of operated eyes with the VA more than 0.3 after 3 mons of the operation in macular normal group subretinal interspace group and other macular disease group were significantly different (χ2=18.91, P＜0.01). Conclusion OCT can precisely detect the structural changes of macula after retinal reattachment and assess visual function after surgery of retinal detachment. (Chin J Ocul Fundus Dis, 2002, 18: 266-268)
ObjectiveTo improve the knowledge of pulmonary actinomycosis.MethodsThree cases of pulmonary actinomycosis in this hospital and 65 cases reported in China were analyzed retrospectively.ResultsAmong the 68 patients 49 were male and 19 were female aged 6 to 77 years old. The most common clinical manifestations were cough, sputum and fever. Inflammatory indicators was slightly elevated. The most common site was on the right upper lung. The typical CT manifestations were the low-density liquefaction necrotic zone in the center of the mass with vacuoles of different sizes, namely, "air-space consolidation". Positron emission computed tomography showed a mild metabolic increase in lesions. The 68 patients were confirmed by surgery, CT guided percutaneous lung puncture or bronchoscopic biopsy. The average time of the diagnosis was 10 months while the longest time was 6.4 years. The rate of first diagnosis was 5.9%. Forty-one cases were treated with antibiotics alone and 12 cases were treated with simple operation, the rest were treated by antibiotics combined with surgical treatment. The cure rate was 88.7%. Although active treatment was conducted 3 patients in this hospital were not cured.ConclusionsThe clinical features of pulmonary actinomycosis are atypical and the misdiagnosis rate is high. When pulmonary actinomycosis is suspected, it should be fully communicated with the microbiologist to ensure the cultivation in anaerobic environment and extension of the incubation cycle. Tissue culture and pathological biopsy should be actively performed. Treatment depends on antibiotics or surgery with good prognosis, but for some cases the prognosis is not optimistic.
ObjectiveTo compare home blood pressure monitoring (HBPM) versus ambulatory blood pressure monitoring (ABPM) versus office blood pressure monitoring (OBPM) in diagnosis and management of hypertension, and to find the optimal blood pressure measurement and management.MethodsThe following were compared among three BP monitoring, such as cost-effectiveness, prognostic value of target organ damage (TOD), predictive value of the progress in chronic kidney disease (CKD) and blood pressure variety (BPV). ResultsCompared to OBPM, ABPM was the most cost-effective method in the primary diagnosis of hypertension, but HBPM was the optimal method in long-term and self-management in hypertension. In hypertensives, compared to OBPM, HBPM and ABPM, especially HBPM, had a stronger predictive value for cardiovascular events, stroke, end-stage renal dysfunction (ESRD) and all-cause mortality. In hypertensives with renal dysfunction, controlling HBPM and ABPM, especially controlling ABPM, was an effective way to slow the progress in renal dysfunction, to decrease cardiovascular events, and to decrease the need of dialysis. All BPV derived from OBPM, ABPM and HBPM had a predictive significance of cardiovascular events, and HBPM BPV performed the best.ConclusionCompared to OBPM, ABPM is the best method in primary diagnosis of hypertension and BP control in CKD patients, while HBPM is the best method in predicting and in evaluating BPV, as well as in long-term and self-management in hypertension.
Heart failure is a disease that seriously threatens human health and has become a global public health problem. Diagnostic and prognostic analysis of heart failure based on medical imaging and clinical data can reveal the progression of heart failure and reduce the risk of death of patients, which has important research value. The traditional analysis methods based on statistics and machine learning have some problems, such as insufficient model capability, poor accuracy due to prior dependence, and poor model adaptability. In recent years, with the development of artificial intelligence technology, deep learning has been gradually applied to clinical data analysis in the field of heart failure, showing a new perspective. This paper reviews the main progress, application methods and major achievements of deep learning in heart failure diagnosis, heart failure mortality and heart failure readmission, summarizes the existing problems and presents the prospects of related research to promote the clinical application of deep learning in heart failure clinical research.