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SARS-CoV-2 infection presenting as sustained atrial flutter and advanced ventricular dysfunction SARS-CoV-2感染表现为持续心房扑动和晚期心室功能障碍
Pub Date : 2020-01-01 DOI: 10.15761/ccsr.1000155
J. Su, M. Weisert, M. Silka, Y. Bar-Cohen, J. Menteer
Viral infections may affect the cardiovascular system in various ways. A number of viruses are known to cause myocarditis and pericarditis, which may result in severe impairment of ventricular function leading to decompensated heart failure [1]. Viral infections may also cause systemic inflammatory response syndrome and septic shock from exaggerated immune inflammatory response [2]. Certain viruses have also been linked to development of cardiac arrhythmias [3,4]. In these cases, evidence of myocardial inflammation is often found. However, arrhythmias are sometimes the only indicator of cardiac involvement in viral infections. Additionally, myocardial failure of any cause can raise atrial and ventricular filling pressures, resulting in increased myocardial fiber stress, potentially inducing arrhythmias or triggering arrhythmias.
病毒感染可以通过多种方式影响心血管系统。已知多种病毒可引起心肌炎和心包炎,可导致严重的心室功能损害,导致失代偿性心力衰竭[1]。病毒感染还可因免疫炎症反应过度而引起全身炎症反应综合征和感染性休克[2]。某些病毒也与心律失常的发生有关[3,4]。在这些病例中,经常发现心肌炎症的证据。然而,心律失常有时是病毒感染中心脏受累的唯一指标。此外,任何原因的心肌衰竭均可提高心房和心室充盈压力,导致心肌纤维应激增加,可能诱发或触发心律失常。
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引用次数: 1
A rare case of foetal endocardial fibroelastosis diagnosed on prenatal sonography 产前超声诊断胎儿心内膜纤维弹性增生1例
Pub Date : 2020-01-01 DOI: 10.15761/ccsr.1000139
Sundeep Nvk, M. Venkatesh
Foetal Endocardial Fibroelastosis (EFE) is a rare cardiac disorder, characterised by echogenic thickening of the endocardium and decreased ventricular contractility, secondary to proliferation of elastic and collagen fibres. In this case report we present a case of endocardial fibroelastosis with review of literature regarding etiopathogenesis, classical features and prognosis.
胎儿心内膜纤维弹性增生症(EFE)是一种罕见的心脏疾病,其特征是心内膜回声增厚和心室收缩力下降,继发于弹性纤维和胶原纤维的增生。在这个病例报告中,我们提出了一例心内膜纤维弹性增生症,并回顾了有关其发病机制、典型特征和预后的文献。
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引用次数: 0
Perioperative considerations of an extended forequarter amputation for recurrent high-grade radiation-induced sarcoma: A case report 延长前肢截肢治疗复发性高级别放射性肉瘤的围手术期考虑:1例报告
Pub Date : 2020-01-01 DOI: 10.15761/ccsr.1000149
Alexander Stoker, Jeff Mueller, Christopher A. Thunberg, K. Goulding, S. Beamer, M. Hinni, A. Rebecca, C. Beauchamp, Andrew W. Gorlin
Forequarter amputation is a radical surgical procedure involving removal of the entire upper extremity and shoulder girdle and is most commonly performed in the management of aggressive upper extremity malignancies. A number of perioperative challenges can arise during extended resections including postoperative respiratory compromise due to altered chest wall mechanics, potential need for lung isolation, selecting appropriate sites for vascular access, complex fluid and hemodynamic resuscitation, optimizing conditions for free flap viability, and managing pain and the psychological impact of such a significant operation. Here we present a case of an extended forequarter amputation with a multidisciplinary team for the management of a recurrent high-grade radiation-induced sarcoma. lateral decubitus position and the right arm, chest wall and were prepped and draped. The plastic surgery began by preparing the forearm for a free fillet flap, but delaying the anastomosis until the extremity was removed. The surgical teams then performed a right forequarter amputation with neck dissection and lymphadenectomy, costotransversectomy from C7 to T2, and chest wall resection. The brachial plexus, external jugular vessels and internal jugular vein were divided. Left lung isolation was required during the chest wall resection involving the first through fifth ribs, sternoclavicular joint, a portion of the manubrium, right upper lobectomy, and total lung pulmonary decortication. The right upper extremity was then removed from the body, leaving a 17 x 25 centimeter defect. The plastic surgery team then removed the free fillet flap from the extremity on a sterile back table, and inset the free forearm fillet flap, anastomosing the brachial artery and vein of the free fillet flap to the lingual artery and anterior cervical vein, respectively. Then 2000 units of heparin were administered intravenously. Reconstruction of the chest wall was performed with a 15 x 18 cm Goretex mesh, and the flap was inset and incisions reapproximated. The surgical time of the procedure was 10 hours and 21 minutes.
前肢截肢是一种包括切除整个上肢和肩带的根治性手术,最常用于治疗恶性上肢肿瘤。在大范围切除过程中,围手术期会出现许多挑战,包括由于胸壁力学改变导致的术后呼吸损害、肺隔离的潜在需求、选择合适的血管通路、复杂的液体和血流动力学复苏、优化自由皮瓣存活的条件、以及控制这种重大手术的疼痛和心理影响。在这里,我们提出了一个延长前肢截肢与多学科团队的管理复发高级别放射诱导肉瘤的情况。侧卧位和右臂、胸壁均做好准备,并披挂。整形手术首先为前臂准备游离的鱼片瓣,但将吻合术推迟到四肢被移除。手术小组随后进行了右前肢截肢,颈部清扫和淋巴结切除术,从C7到T2的肋横切术和胸壁切除术。分为臂丛、颈外血管和颈内静脉。在包括第一至第五肋骨、胸锁关节、部分胸柄、右上肺叶切除术和全肺去皮术的胸壁切除术中,需要隔离左肺。右上肢随后被从身体上取下,留下一个17 x 25厘米的缺损。然后,整形外科团队在无菌手术台上从四肢取出游离鱼片瓣,置入前臂游离鱼片瓣,将游离鱼片瓣的肱动脉和静脉分别与舌动脉和颈前静脉吻合。然后静脉注射2000单位肝素。用15 × 18 cm Goretex补片重建胸壁,置入皮瓣并重新逼近切口。手术时间为10小时21分钟。
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引用次数: 0
Intra-myometrial pregnancy-A rare site of ectopic pregnancy 子宫肌内妊娠-一种罕见的异位妊娠
Pub Date : 2020-01-01 DOI: 10.15761/ccsr.1000137
M. Venkatesh, Sindhuja Kln, Sundeep Nvk
A 35-year-old G2 P1 L1 lady presented with amenorrhea of 7 weeks and mild lower abdominal pain. No prior history of abortion or dilatation and curettage. Urine pregnancy test was positive and early antenatal ultrasound was advised. Transvaginal sonography was performed which revealed a gestational sac in the myometrium close to serosa (Figure 1A). Fetal pole was seen within the sac with good fetal cardiac activity (Figure 1B). MRI pelvis was done for better delineation of the sac. MRI (Figure 2A and 2C) showed gestational sac with hypointense fetal pole in the anterior myometrium as revealed on USG. MRI (Figure 2B) revealed additional finding of T2 curvilinear hyperintense tract which was seen extending from the endometrial cavity to gestational sac. Bilateral adnexa were normal and there was no free fluid in pelvis. USG and MRI features were suggestive of intramyometrial pregnancy. In view of location of gestational sac in the myometrium close to serosa with high risk of rupture, wedge resection of myometrium was performed (Figure 2D). Patient was discharged on 5th post-operative day with no complications. Abstract
35岁,G2 P1 L1女性,闭经7周,轻度下腹痛。既往无流产史或宫内扩张和刮宫史。尿妊娠试验阳性,建议尽早行产前超声检查。经阴道超声检查显示子宫肌层靠近浆膜处有妊娠囊(图1A)。囊内可见胎极,胎儿心脏活动良好(图1B)。为了更好地描绘囊,进行了骨盆MRI检查。MRI(图2A和2C)显示USG显示妊娠囊前肌层有低强度的胎极。MRI(图2B)显示T2曲线型高信号束,从子宫内膜腔延伸至妊娠囊。双侧附件正常,骨盆内无游离液体。USG和MRI表现提示子宫内膜内妊娠。考虑到妊娠囊位于肌层靠近浆膜,破裂风险高,对子宫肌层行楔形切除(图2D)。术后第5天出院,无并发症。摘要
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引用次数: 2
Electroencephalographic evidence of organic alteration in a patient with SARS-CoV2 induced delirium SARS-CoV2致谵妄患者器质性改变的脑电图证据
Pub Date : 2020-01-01 DOI: 10.15761/ccsr.1000152
J. Pastor, L. Vega-Zelaya, E. Parada, J. L. Mateos
Neurological complications in COVID-19 infected patients have been extensively reported. CNS affections include encephalitis, toxic encephalopathy, ageusia and anosmia, headache or acute cerebrovascular disease and delirium [1-5]. The mechanisms of CNS infection by CoV2 are still debated and it has been proposed a direct invasion through blood-brain barrier, a neuronal pathway, hypoxia damage, immune-response mediated injury or angiotensin-converter enzyme 2, among others [2,6,7].
COVID-19感染患者的神经系统并发症已被广泛报道。中枢神经系统的影响包括脑炎、中毒性脑病、老年和嗅觉丧失、头痛或急性脑血管疾病和谵妄[1-5]。CoV2感染中枢神经系统的机制仍有争议,有人提出它可能通过血脑屏障、神经元通路、缺氧损伤、免疫反应介导的损伤或血管紧张素转换酶2等直接侵入[2,6,7]。
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引用次数: 1
Penetrating excimer Laser-assisted keratoplasty for corneal epithelial downgrowth in childhood 穿透准分子激光辅助角膜移植术治疗儿童角膜上皮发育迟缓
Pub Date : 2020-01-01 DOI: 10.15761/ccsr.1000143
Barbora Majkutova, F. Flockerzi, M. BertholdSeitz, Celestina Schober, A. Viestenz
A 5-year-old boy was presented in our department one month after corneal injury caused by metal stick, complaining of pain in his right eye and pronounced photosensitivity. The primary removal of corneal foreign body took place in an external clinic. BCVA was 0.6 OD and 1.0 OS. The slit-lamp biomicroscopy examination revealed a corneal intrastromal whitish membranous structure in the right eye spreading over the visual axis (Figure 1).
一名5岁男孩因金属棒致角膜损伤1个月后就诊于我科,主诉右眼疼痛并明显光敏。第一次角膜异物清除是在外部诊所进行的。BCVA为0.6 OD, 1.0 OS。裂隙灯生物显微镜检查显示右眼角膜间质内白色膜状结构沿视轴扩散(图1)。
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引用次数: 1
Old causes still alive - A case report 旧的原因仍然存在-一份病例报告
Pub Date : 2020-01-01 DOI: 10.15761/ccsr.1000140
J. Berg
Prevalence patterns for infectious diseases change over time and the testing of their presence at referral to hospitals may be reduced when the incidence rates are low. A case is presented, where a suspicion of syphilis as the maybe reason for a stabbing in a train, firstly came during the forensic psychiatric interview. This underscores the need for taking rare causes into consideration and for the use of psychiatrists, not only psychologists at forensic examination of mental illness.
传染病的流行模式随着时间的推移而变化,当发病率较低时,可减少在转诊到医院时对其是否存在进行检测。提出了一个案例,其中怀疑梅毒可能是在火车上刺伤的原因,首先是在法医精神病学采访期间。这强调了在精神疾病的法医检查中需要考虑到罕见的原因和使用精神病学家,而不仅仅是心理学家。
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引用次数: 0
COVID-19 infection presenting as massive, multi-organ thromboembolism COVID-19感染表现为大量多器官血栓栓塞
Pub Date : 2020-01-01 DOI: 10.15761/ccsr.1000154
M. Bongiovanni, F. Bini, B. Bodini, G. Xhepa, A. Marra, G. D. Angelis
The emergence of Coronavirus disease 2019 (COVID-19) has presented an unprecedented challenge for the healthcare community across the world. Based on the rapid increase in the rate of human infection, the World Health Organization (WHO) has classified the COVID-19 outbreak as a pandemic [1-3]. Respiratory involvement, presenting as mild flu-like illness to potentially lethal acute respiratory distress syndrome or fulminant pneumonia, is the dominant clinical manifestation of COVID-19 [4]. However, pre-existing cardiovascular disease (CVD) and CV risk factors may enhance vulnerability to COVID-19; further, COVID-19 can worsen underlying CVD and even precipitate new cardiac complications, due to possible endothelial dysfunction [5-6]. Furthermore, patients with COVID-19 pneumonia exhibit a number of coagulation abnormalities that have been associated with a higher mortality rate [7-8]; in particular, severe lung inflammation and impaired pulmonary gas exchange in COVID‐19 infected individuals has been suggested to be due to the up-regulation of pro‐inflammatory cytokines [9]. Further, it has been demonstrated that the activation of the coagulation system is relevant in the pathogenesis of acute respiratory distress syndrome (ARDS), one of the most common complications of COVID‐19 infection [10]. As a consequence, COVID-19 infection may predispose to both venous and arterial thromboembolic disease due to excessive inflammation, hypoxia, immobilization and diffuse intravascular coagulation (DIC).
2019冠状病毒病(COVID-19)的出现给全球医疗界带来了前所未有的挑战。基于人类感染率的快速上升,世界卫生组织(WHO)将COVID-19疫情列为大流行[1-3]。呼吸道受累是COVID-19的主要临床表现,表现为轻微的流感样疾病,可发展为潜在致命的急性呼吸窘迫综合征或暴发性肺炎[4]。然而,已有的心血管疾病(CVD)和CV危险因素可能会增加对COVID-19的易感性;此外,由于可能存在内皮功能障碍,COVID-19可加重潜在的CVD,甚至引发新的心脏并发症[5-6]。此外,COVID-19肺炎患者表现出许多凝血功能异常,这与较高的死亡率相关[7-8];特别是,在COVID - 19感染个体中,严重的肺部炎症和肺部气体交换受损被认为是由于促炎细胞因子的上调[9]。此外,有研究表明凝血系统的激活与急性呼吸窘迫综合征(ARDS)的发病机制有关,ARDS是COVID - 19感染最常见的并发症之一[10]。因此,COVID-19感染可能由于过度炎症、缺氧、固定化和弥漫性血管内凝血(DIC)而易患静脉和动脉血栓栓塞性疾病。
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引用次数: 0
Transient hypoxia following nitrogen spray cryotherapy for Barrett’s Esophagus: A case report 氮气喷雾冷冻治疗Barrett食管后短暂缺氧1例
Pub Date : 2020-01-01 DOI: 10.15761/ccsr.1000148
atthew L Ritz, A. Murray, Andrew W. Gorlin
The patient was a 70-year-old male with a past medical history significant for gastro esophageal reflux disease, Barrett’s Esophagus, and Class III obesity with a body mass index greater than 40. The patient had undergone previous radio frequency ablation for treatment of Barrett’s Esophagus. The patient presented for a surveillance endoscopy and nitrogen cryotherapy. A nasal cannula was placed with side stream capnography, and intravenous induction of anesthesia was performed with propofol and lidocaine. A propofol infusion was used for maintenance of anesthesia and titrated appropriately to maintain depth of anesthesia, the patient was breathing spontaneously for the duration of the case. The endoscope was introduced without complication. Nitrogen spray cryotherapy was performed for twenty seconds for two cycles at each treatment site. A total of four different sites were ablated. Ventilation tubing was inserted adjacent to the endoscope and suction aided ventilation of gases was performed through the ventilation tubing during, and for 20 seconds after the ablation procedure. The patient developed hypoxia with desaturation into the 80s by pulse oximetry during each ablation. The hypoxia resolved each time ablation was completed. The procedure was ultimately completed successfully and the patient was taken to the PACU with a nasal cannula in place which was ultimately discontinued, he was discharged without further episodes of hypoxia.
患者为70岁男性,既往有胃食管反流病、Barrett食管、III级肥胖病史,体重指数大于40。患者曾接受射频消融治疗巴雷特食管。患者接受内窥镜检查和氮冷冻治疗。侧流造影下置入鼻插管,异丙酚和利多卡因静脉诱导麻醉。使用异丙酚输注维持麻醉,并适当滴定以维持麻醉深度,患者在病例期间自主呼吸。引入内窥镜无并发症。在每个治疗部位进行2个周期的氮喷雾冷冻治疗,持续20秒。共消融了四个不同的部位。在内窥镜附近插入通气管,在消融过程中和消融后20秒通过通气管进行吸力辅助气体通气。在每次消融过程中,脉搏血氧测量显示患者出现缺氧,血饱和度达到80。每次消融完成后缺氧消失。手术最终成功完成,患者被送往PACU,并在适当的位置使用鼻插管,最终停止使用,他出院时没有再发生缺氧。
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引用次数: 0
The Use of I-gel laryngeal mask with selective endobronchial blocker for uniportal video assisted thoracic surgery i -凝胶喉罩与选择性支气管内阻滞剂在单门视频辅助胸外科手术中的应用
Pub Date : 2020-01-01 DOI: 10.15761/ccsr.1000153
G. D. Gregorio, N. Sella, A. Pangoni, D. Pittarello, P. Navalesi, F. Rea, A. Dell’Amore
The development of video-assisted thoracoscopic surgery has led to a rising interest in decreasing the invasiveness not only of the surgical procedures, but also of the anaesthetic management. We report our preliminary experience using a supraglottic device and a bronchial blocker without neuromuscular blockade during uniportal video assisted thoracic surgery.
随着电视胸腔镜手术的发展,人们对减少手术过程的侵入性以及麻醉管理的兴趣日益浓厚。我们报告我们在单门静脉视频辅助胸外科手术中使用声门上装置和无神经肌肉阻断的支气管阻断剂的初步经验。
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引用次数: 0
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Clinical Case Studies and Reports
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