Group B Streptococcus(GBS;Streptococcus agalactiae)is a gram-positive coccus that colonizes the gastrointestinal and genital tracts in adults,as well as the upper respiratory tract in infants.While it has been thought...Group B Streptococcus(GBS;Streptococcus agalactiae)is a gram-positive coccus that colonizes the gastrointestinal and genital tracts in adults,as well as the upper respiratory tract in infants.While it has been thought that GBS only results in invasive disease in pregnant females and neonates,recent literature has suggested an increasing incidence of invasive GBS among non-pregnant individuals within the United States.展开更多
Prostatic abscess is a rare entity with an incidence of 0.5% to 2.5% in all prostate diseases and usually occurs in the 5th and 6th decades of life with immunocompromised status,Prostatic abscess might be a process of...Prostatic abscess is a rare entity with an incidence of 0.5% to 2.5% in all prostate diseases and usually occurs in the 5th and 6th decades of life with immunocompromised status,Prostatic abscess might be a process of evolution from acute prostatitis,Klebsiella pneumoniae is the leading microorganism in the diabetic patients of prostatic abscess in Taiwan,A 60-year-old diabetic man,with a one-week history of acute bacterial prostatitis was reported in this study,presenting to the emergency department with sudden altered mental status,The abdominal computed tomographic scan demonstrated lobulated prostatic abscess and multiple septic pulmonary emboli with lung abscesses,Analysis of cerebrospinal fluid showed white blood cells of 10 771 counts/mm3 with segmented neutrophils of 99%,Cultures of blood,cerebrospinal fluid and sputum yielded Klebsiella pneumoniae,We concluded that computed tomographic scan can make a definite diagnosis of prostatic abscess associated with complications and management with empiric antibiotics and adequate drainage is suggested.展开更多
Transcranial Doppler(TCD) is useful for investigation of intracranial arterial blood flow and can be used to detect a real-time embolic signal. Unfortunately, artefacts can mimic the embolic signal, complicating inter...Transcranial Doppler(TCD) is useful for investigation of intracranial arterial blood flow and can be used to detect a real-time embolic signal. Unfortunately, artefacts can mimic the embolic signal, complicating interpretation and necessitating expert-level opinion to distinguish the two. Resolving this situation is critical to achieve improved accuracy and utility of TCD for patients with disrupted intracranial arterial blood flow, such as stroke victims. A common type of stroke encountered in the clinic is cryptogenic stroke(or stroke with undetermined etiology), and patent foramen ovale(PFO) has been associated with the condition. An early clinical trial of PFO closure effect on secondary stroke prevention failed to demonstrate any benefit for the therapy, and research into the PFO therapy generally diminished. However, the recent publication of large randomized control trials with demonstrated benefit of PFO closure for recurrent stroke prevention has rekindled the interest in PFO in patients with cryptogenic stroke. To confirm that emboli across the PFO can reach the brain, TCD should be applied to detect the air embolic signal after injection of agitated saline bubbles at the antecubital vein. In addition, the automated embolic signal detection method should further facilitate use of TCD for air embolic signal detection after the agitated saline bubbles injection in patients with cryptogenic stroke and PFO.展开更多
BACKGROUND Craniofacial necrotizing fasciitis(CNF)is an uncommon but fatal infection that can spread rapidly through the subfascial planes in the head and neck region.Symptoms usually progress rapidly,and early manage...BACKGROUND Craniofacial necrotizing fasciitis(CNF)is an uncommon but fatal infection that can spread rapidly through the subfascial planes in the head and neck region.Symptoms usually progress rapidly,and early management is necessary to optimize outcomes.CASE SUMMARY A 43-year-old man visited our hospital with left hemifacial swelling involving the buccal and submandibular areas.The patient had fever for approximately 10 d before visiting the hospital,but did not report any other systemic symptoms.Computed tomography scan demonstrated an abscess with gas formation.After surgical drainage of the facial abscess,the patient’s systemic condition worsened and progressed to septic shock.Further examination revealed pulmonary and renal abscesses.Renal percutaneous catheter drainage was performed at the renal abscess site,which caused improvement of symptoms.The patient showed no evidence of systemic complications during the 4-mo post-operative follow-up period.CONCLUSION As the patient did not improve with conventional CNF treatment and symptoms only resolved after controlling the infection,the final diagnosis was secondary CNF with septic emboli.Aggressive surgical decompression is important for CNF management.However,if symptoms worsen despite early diagnosis and management,such as pus drainage and surgical intervention,clinicians should consider the possibility of a secondary abscess from internal organs.展开更多
Septic pulmonary emboli rarely cause respiratory failure that requires mechanical ventilation. The most common causes of septic pulmonary emboli are related to intravenous drug abuse, indwelling intravenous catheters,...Septic pulmonary emboli rarely cause respiratory failure that requires mechanical ventilation. The most common causes of septic pulmonary emboli are related to intravenous drug abuse, indwelling intravenous catheters, endocarditis and septic pelvic thrombophlebitis. In addition, soft tissue injury-related thrombophlebitis rarely causes septic pulmonary emboli. We describe a unique case of a 43-year-old man who developed septic thrombophlebitis of the femoral vein following soft tissue injury from trauma to the shin with ensuing septic pulmonary emboli which necessitated endotracheal intubation and mechanical ventilation. The patient required mechanical ventilation for eleven days, developed empyema and grew out methicillin-resistant Staphylococcus aureus on blood cultures. A transesophageal echocardiogram was normal, and there was no indication of bacterial endocarditis. In addition to eleven days of mechanical ventilation, the patient was treated with intravenous heparin, cefepime and clindamycin. These medications were then discontinued and the patient was treated with weight-adjusted vancomycin. Following the return of cultures, the patient was treated for six weeks with ceftaroline 600 mg IV twice a day. In addition, the patient received bilateral thoracentesis followed by chest tube drainage until resolution of the pleural effusions. The patient made a complete recovery. We describe this case and the implications for differential diagnosis and treatment of these two uncommon conditions.展开更多
Acute myocardial infarction (AMI) is a leading cause of death worldwide. It has been clinically classified into 1) ischemic from a primary coronary event (e.g., plaque rupture or thrombotic occlusion), 2) ischemic fro...Acute myocardial infarction (AMI) is a leading cause of death worldwide. It has been clinically classified into 1) ischemic from a primary coronary event (e.g., plaque rupture or thrombotic occlusion), 2) ischemic from a supply-and-demand mismatch and c) ischemic from a percutaneous coronary interventions (PCI). Catheter-based PCI has been frequently used as an alternative to conventional bypass surgery for patients at high risk. However, this method of treatment is associated with microvascular obstruction (MVO) by dislodged microemboli that results in left ventricular (LV) dysfunction/remodeling, perfusion deficits, microinfarction and arrhythmia. The contributions of microemboli after revascularization of AMI have been acknowledged by major cardiac and interventional societies. Recent studies showed that Emboli Detection and Classification (EDAC) Quantifier offers increased sensitivity and capability for detecting dislodged coronary microemboli during PCI. Coronary microembolization can be detected directly by monitoring intra-myocardial contrast opacification on contrast echocardiography, increasing F-18 fluorodeoxyglucose (FDG) uptake on positron emission tomography, loss/diminution of signal on first pass perfusion and hypoenhanced zone on contrast enhanced magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) and indirectly by ST-segment elevation on electro-cardiography (ECG). The relations between volumes/sizes of microemboli, visibility of microinfarct, myocardial perfusion and LV function are still under intensive discussions. Non-invasive imaging can play important role in assessing these parameters. This review shed the light on the techniques used for detecting coronary microemboli, microvascular obstruction and microinfarct and the short- and long-term effects of microemboli on LV function, structure and perfusion.展开更多
Retinal emboli are opacities identified in retinal arterioles and are often incidental findings on ophthalmic examination. They are generally composed of cholesterol, platelet-fibrin, or calcium and are thought to ari...Retinal emboli are opacities identified in retinal arterioles and are often incidental findings on ophthalmic examination. They are generally composed of cholesterol, platelet-fibrin, or calcium and are thought to arise from carotid arteries, coronary arteries, or cardiac valves. In the general population, the estimated prevalence is 0.2% to 1.3%, and the estimated incidence is 0.9% to 2.9%. The transient nature of retinal emboli likely explains the variations between and within these reported figures. The strongest risk factor for retinal emboli is smoking, which has been reported consistently across many studies. Other likely risk factors include older age, hypertension, male sex, total cholesterol, coronary artery disease, and history of coronary artery bypass grafting. The presence of multiple risk factors, as is common in many patients, confers a higher risk for retinal emboli. Several studies suggest that retinal emboli predict an increase in stroke-related, all-cause, and possibly cardiovascular mortality. Due to these sequelae, patients often undergo further workup, most commonly carotid ultrasonography. However, given the low prevalence of significant carotid disease in patients with retinal emboli, further workup, such as carotid ultrasound, should be reserved for those with risk factors for carotid disease. All patients would benefit from medical optimization and coordinated care with the primary care physician.展开更多
The etiology of perinatal arterial ischemic strokes may be maternal, fetal or both. Venous thrombo-embolism is almost always catheter associated in new-borns. Preliminary guidelines for management of perinatal arteria...The etiology of perinatal arterial ischemic strokes may be maternal, fetal or both. Venous thrombo-embolism is almost always catheter associated in new-borns. Preliminary guidelines for management of perinatal arterial ischemic strokes exist but are mostly based on adult studies. We report a unique case of perinatal arterial ischemic stroke, lower extremity arterial and inferior vena-caval thrombosis. Our patient was treated with unfractionated heparin for 10 days then switched to low molecular heparin to complete 6 months of therapy. The patient responded well to therapy and shows minimal signs of permanent neurologic deficits after 6 months.展开更多
Pulmonary tumour thrombotic microangiopathy(PTTM)is a rare but under-recognised cause of rapidly progressive pulmonary hypertension(PH)and cor pulmonale,characterised by diffuse obstruction of small pulmonary arteries...Pulmonary tumour thrombotic microangiopathy(PTTM)is a rare but under-recognised cause of rapidly progressive pulmonary hypertension(PH)and cor pulmonale,characterised by diffuse obstruction of small pulmonary arteries by metastatic tumour cells.These tumour emboli lead to obstructive intimal proliferation and in situ thrombosis within the pulmonary vasculature,further compromising the overall permeability of the pulmonary vascular bed and exacerbating PH.[1]The clinical and imaging manifestations of PTTM often overlap with those of other causes of PH,including chronic thromboembolic PH,pulmonary veno-occlusive disease and pulmonary capillary haemangiomatosis,often leading to diagnostic delays.展开更多
s To determine the relative value of transesophageal echocardiography (TEE) and tr ansthoracic echocardiography (TTE) in exploring the potential embolic source (PE S) in heart and aortic arch and to study the clinica...s To determine the relative value of transesophageal echocardiography (TEE) and tr ansthoracic echocardiography (TTE) in exploring the potential embolic source (PE S) in heart and aortic arch and to study the clinical significance of aortic arc h athersclerosis (AAA) Methods Forty nine patients with cerebral embolism were included in this study TEE an d TTE were used to evaluate the potential source of emboli in aortic arch, heart and duplex in the carotid artery An atherosclerotic lesion of the aortic arch was defined as normal, mild plaque, moderate plaque, and protruding plaque or m obile plaque Results Of the 49 patients, 31(63%) patients showed evidence of AAA: 7 (14 1%) patients were mild, 9 (18 4%) were moderate and 15 (30 6%) were severe In those 15 p atients, 11 had neither severe ICAA nor heart disease Thirty three patients h ad internal carotid arterial atherosclerosis (ICAA) The potential sources of e mbolization of heart and aortic arch is 48 98% by TEE, but only 18 4% by TTE; 9 patients had heart disease Age and ICAA were significantly correlated with A AA Conclusion At present, TEE is a better method for exploring atherosclerotic lesions in the thoracic aorta AAA is an important potential source of cerebral embolic stroke展开更多
Introduction:ABCD^(2) risk score and cerebral microemboli detected by transcranial Doppler(TCD)have been separately shown to the predict risk of recurrent acute stroke.We studied whether ABCD2 risk score predicts cere...Introduction:ABCD^(2) risk score and cerebral microemboli detected by transcranial Doppler(TCD)have been separately shown to the predict risk of recurrent acute stroke.We studied whether ABCD2 risk score predicts cerebral microemboli in patients with hyper-acute symptomatic carotid artery stenosis.Participants and methods:We studied 206 patients presenting within 2 weeks of transient ischaemic attack or minor stroke and found to have critical carotid artery stenosis(≥50% ).86 patients(age 70±1(SEM:years),58 men,83 Caucasian)had evidence of microemboli;72(84% )of these underwent carotid endarterectomy(CEA).120 patients(age 72±1 years,91 men,113 Caucasian)did not have microemboli detected;102(85% )of these underwent CEA.Data were analysed using X2 and Mann–Whitney U tests and receiver operating characteristic(ROC)curves.Results:140/206(68% :95% CI 61.63 to 74.37)patients with hyper-acute symptomatic critical carotid stenosis had an ABCD2 risk score≥4.There was no significant difference in the NICE red flag criterion for early assessment(ABCD^(2) risk score≥4)for patients with cerebral microemboli versus those without microemboli(59/86 vs 81/120 patients:OR 1.05 ABCD2 risk score≥4(95% CI 0.58 to 1.90,p=0.867)).The ABCD2 risk score was<4 in 27 of 86(31% :95% CI 21 to 41)embolising patients and in 39 of 120(31% :95% CI 23 to 39)without cerebral microemboli.After adjusting for pre-neurological event antiplatelet treatment(APT),area under the curve(AUC)of ROC for ABCD2 risk score showed no prediction of cerebral microemboli(no pre-event APT,n=57:AUC 0.45(95% CI 0.29 to 0.60,p=0.531);preevent APT,n=147:AUC 0.51(95% CI 0.42 to 0.60,p=0.804)).Conclusions:The ABCD2 score did not predict the presence of cerebral microemboli or carotid disease in over one-quarter of patients with symptomatic critical carotid artery stenosis.On the basis of NICE guidelines(refer early if ABCD2≥4),assessment of high stroke risk based on ABCD2 scoring may lead to inappropriate delay in urgent treatment in many patients.展开更多
The purpose of this study is to establish the simulation model of the gas emboli by analyzing reasons for features of gas emboli Doppler ultrasound signals. It is useful for the further classification of the solid emb...The purpose of this study is to establish the simulation model of the gas emboli by analyzing reasons for features of gas emboli Doppler ultrasound signals. It is useful for the further classification of the solid emboli and gas emboli. First, the model of the radiation force and the drag force is used to calculate forces acting on the gas emboli. Second, the acceleration of the gas emboli is calculated in both the radial direction and the axial direction of the vessel, which is used to calculate the trajectory of the gas emboli in the vessel. Finally, the computer simulation model is established for the gas emboli. Doppler ultrasound signals of the gas emboli and the solid emboli are generated in the simulation experiment. Experimental results show that compared with the solid emboli, the gas emboli acted by the radiation force and the drag force will result in the frequency-domain broaden in the Doppler spectrogram. When the gas emboli circulate from the low speed area to the high speed one and then from the high speed area back to the low speed one, a ＂V＂ shape will be shown in the spectrogram of gas emboli signals. When the gas emboli circulate from the low speed area to the high speed one or from the high speed area to the low speed one, a diagonal shape will be shown for gas emboli signals. It is also shown that features of simulated gas emboli signals match with those of gas emboli signals sampled from clinic. All demonstrate that the simulation method of the gas emboli is reasonable.展开更多
Objective To summarize and analyze the morphology and distribution of embolus in patients suspected acute pulmonary embolism. Methods The CT pulmonary angiography(CTPA) imagings of 279 patients suspected acute pulmona...Objective To summarize and analyze the morphology and distribution of embolus in patients suspected acute pulmonary embolism. Methods The CT pulmonary angiography(CTPA) imagings of 279 patients suspected acute pulmonary embolism were analyzed retrospectively展开更多
Objective To investigate the expression of tissue factor and explore its clinical significances in pulmonary artery after acute pulmonary thromboembolism.Methods Thirty-four Japanese white rabbits(LevelⅡanimals)were ...Objective To investigate the expression of tissue factor and explore its clinical significances in pulmonary artery after acute pulmonary thromboembolism.Methods Thirty-four Japanese white rabbits(LevelⅡanimals)were randomly(random number)assigned into four groups:group A(specimen of pulmonary artery was taken 3 hours展开更多
Although the perioperative bleeding complications and the major side effects of blood transfusion have always been the primary concern in liver transplantation(OLT),the possible cohesion of an underestimated intrinsic...Although the perioperative bleeding complications and the major side effects of blood transfusion have always been the primary concern in liver transplantation(OLT),the possible cohesion of an underestimated intrinsic hypercoagulative state during and after the transplant procedure may pose a major threat to both patient and graft survival.Thromboembolism during OLT is characterized not only by a complex aetiology,but also by unpredictable onset and evolution of the disease.The initiation of a procoagulant process may be triggered by various factors,such as inflammation,venous stasis,ischemia-reperfusion injury,vascular clamping,anatomical and technical abnormalities,genetic factors,deficiency of profibrinolytic activity,and platelet activation.The involvement of the arterial system,intracardiac thrombosis,pulmonary emboli,portal vein thrombosis,and deep vein thrombosis,are among the most serious thrombotic events in the perioperative period.The rapid detection of occlusive vascular events is of paramount importance as it heavily influences the prognosis,particularly when these events occur intraoperatively or early after OLT.Regardless of the lack of studies and guidelines on anticoagulant prophylaxis in this setting,many institutions recommend such an approach especially in the subset of patients at high risk.However,the decision of when,how and in what doses to use the various chemical anticoagulants is still a difficult task,since there is no common consensus,even for highrisk cases.The risk of postoperative thromboembolism causing severe hemodynamic events,or even loss of graft function,must be weighed and compared with the risk of an important bleeding.In this article we briefly review the risk factors and the possible predictors of major thrombotic complications occurringin the perioperative period,as well as their incidence and clinical features.Moreover,the indications to pharmacological prophylaxis and the current treatment strategies are also summarized.展开更多
文摘Group B Streptococcus(GBS;Streptococcus agalactiae)is a gram-positive coccus that colonizes the gastrointestinal and genital tracts in adults,as well as the upper respiratory tract in infants.While it has been thought that GBS only results in invasive disease in pregnant females and neonates,recent literature has suggested an increasing incidence of invasive GBS among non-pregnant individuals within the United States.
文摘Prostatic abscess is a rare entity with an incidence of 0.5% to 2.5% in all prostate diseases and usually occurs in the 5th and 6th decades of life with immunocompromised status,Prostatic abscess might be a process of evolution from acute prostatitis,Klebsiella pneumoniae is the leading microorganism in the diabetic patients of prostatic abscess in Taiwan,A 60-year-old diabetic man,with a one-week history of acute bacterial prostatitis was reported in this study,presenting to the emergency department with sudden altered mental status,The abdominal computed tomographic scan demonstrated lobulated prostatic abscess and multiple septic pulmonary emboli with lung abscesses,Analysis of cerebrospinal fluid showed white blood cells of 10 771 counts/mm3 with segmented neutrophils of 99%,Cultures of blood,cerebrospinal fluid and sputum yielded Klebsiella pneumoniae,We concluded that computed tomographic scan can make a definite diagnosis of prostatic abscess associated with complications and management with empiric antibiotics and adequate drainage is suggested.
文摘Transcranial Doppler(TCD) is useful for investigation of intracranial arterial blood flow and can be used to detect a real-time embolic signal. Unfortunately, artefacts can mimic the embolic signal, complicating interpretation and necessitating expert-level opinion to distinguish the two. Resolving this situation is critical to achieve improved accuracy and utility of TCD for patients with disrupted intracranial arterial blood flow, such as stroke victims. A common type of stroke encountered in the clinic is cryptogenic stroke(or stroke with undetermined etiology), and patent foramen ovale(PFO) has been associated with the condition. An early clinical trial of PFO closure effect on secondary stroke prevention failed to demonstrate any benefit for the therapy, and research into the PFO therapy generally diminished. However, the recent publication of large randomized control trials with demonstrated benefit of PFO closure for recurrent stroke prevention has rekindled the interest in PFO in patients with cryptogenic stroke. To confirm that emboli across the PFO can reach the brain, TCD should be applied to detect the air embolic signal after injection of agitated saline bubbles at the antecubital vein. In addition, the automated embolic signal detection method should further facilitate use of TCD for air embolic signal detection after the agitated saline bubbles injection in patients with cryptogenic stroke and PFO.
基金Supported by the National Research Foundation of Korea Grant funded by the Korea Government(MSIT),No.2021R1G1A1008337the Soonchunhyang University Research Fund.
文摘BACKGROUND Craniofacial necrotizing fasciitis(CNF)is an uncommon but fatal infection that can spread rapidly through the subfascial planes in the head and neck region.Symptoms usually progress rapidly,and early management is necessary to optimize outcomes.CASE SUMMARY A 43-year-old man visited our hospital with left hemifacial swelling involving the buccal and submandibular areas.The patient had fever for approximately 10 d before visiting the hospital,but did not report any other systemic symptoms.Computed tomography scan demonstrated an abscess with gas formation.After surgical drainage of the facial abscess,the patient’s systemic condition worsened and progressed to septic shock.Further examination revealed pulmonary and renal abscesses.Renal percutaneous catheter drainage was performed at the renal abscess site,which caused improvement of symptoms.The patient showed no evidence of systemic complications during the 4-mo post-operative follow-up period.CONCLUSION As the patient did not improve with conventional CNF treatment and symptoms only resolved after controlling the infection,the final diagnosis was secondary CNF with septic emboli.Aggressive surgical decompression is important for CNF management.However,if symptoms worsen despite early diagnosis and management,such as pus drainage and surgical intervention,clinicians should consider the possibility of a secondary abscess from internal organs.
文摘Septic pulmonary emboli rarely cause respiratory failure that requires mechanical ventilation. The most common causes of septic pulmonary emboli are related to intravenous drug abuse, indwelling intravenous catheters, endocarditis and septic pelvic thrombophlebitis. In addition, soft tissue injury-related thrombophlebitis rarely causes septic pulmonary emboli. We describe a unique case of a 43-year-old man who developed septic thrombophlebitis of the femoral vein following soft tissue injury from trauma to the shin with ensuing septic pulmonary emboli which necessitated endotracheal intubation and mechanical ventilation. The patient required mechanical ventilation for eleven days, developed empyema and grew out methicillin-resistant Staphylococcus aureus on blood cultures. A transesophageal echocardiogram was normal, and there was no indication of bacterial endocarditis. In addition to eleven days of mechanical ventilation, the patient was treated with intravenous heparin, cefepime and clindamycin. These medications were then discontinued and the patient was treated with weight-adjusted vancomycin. Following the return of cultures, the patient was treated for six weeks with ceftaroline 600 mg IV twice a day. In addition, the patient received bilateral thoracentesis followed by chest tube drainage until resolution of the pleural effusions. The patient made a complete recovery. We describe this case and the implications for differential diagnosis and treatment of these two uncommon conditions.
文摘Acute myocardial infarction (AMI) is a leading cause of death worldwide. It has been clinically classified into 1) ischemic from a primary coronary event (e.g., plaque rupture or thrombotic occlusion), 2) ischemic from a supply-and-demand mismatch and c) ischemic from a percutaneous coronary interventions (PCI). Catheter-based PCI has been frequently used as an alternative to conventional bypass surgery for patients at high risk. However, this method of treatment is associated with microvascular obstruction (MVO) by dislodged microemboli that results in left ventricular (LV) dysfunction/remodeling, perfusion deficits, microinfarction and arrhythmia. The contributions of microemboli after revascularization of AMI have been acknowledged by major cardiac and interventional societies. Recent studies showed that Emboli Detection and Classification (EDAC) Quantifier offers increased sensitivity and capability for detecting dislodged coronary microemboli during PCI. Coronary microembolization can be detected directly by monitoring intra-myocardial contrast opacification on contrast echocardiography, increasing F-18 fluorodeoxyglucose (FDG) uptake on positron emission tomography, loss/diminution of signal on first pass perfusion and hypoenhanced zone on contrast enhanced magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) and indirectly by ST-segment elevation on electro-cardiography (ECG). The relations between volumes/sizes of microemboli, visibility of microinfarct, myocardial perfusion and LV function are still under intensive discussions. Non-invasive imaging can play important role in assessing these parameters. This review shed the light on the techniques used for detecting coronary microemboli, microvascular obstruction and microinfarct and the short- and long-term effects of microemboli on LV function, structure and perfusion.
文摘Retinal emboli are opacities identified in retinal arterioles and are often incidental findings on ophthalmic examination. They are generally composed of cholesterol, platelet-fibrin, or calcium and are thought to arise from carotid arteries, coronary arteries, or cardiac valves. In the general population, the estimated prevalence is 0.2% to 1.3%, and the estimated incidence is 0.9% to 2.9%. The transient nature of retinal emboli likely explains the variations between and within these reported figures. The strongest risk factor for retinal emboli is smoking, which has been reported consistently across many studies. Other likely risk factors include older age, hypertension, male sex, total cholesterol, coronary artery disease, and history of coronary artery bypass grafting. The presence of multiple risk factors, as is common in many patients, confers a higher risk for retinal emboli. Several studies suggest that retinal emboli predict an increase in stroke-related, all-cause, and possibly cardiovascular mortality. Due to these sequelae, patients often undergo further workup, most commonly carotid ultrasonography. However, given the low prevalence of significant carotid disease in patients with retinal emboli, further workup, such as carotid ultrasound, should be reserved for those with risk factors for carotid disease. All patients would benefit from medical optimization and coordinated care with the primary care physician.
文摘The etiology of perinatal arterial ischemic strokes may be maternal, fetal or both. Venous thrombo-embolism is almost always catheter associated in new-borns. Preliminary guidelines for management of perinatal arterial ischemic strokes exist but are mostly based on adult studies. We report a unique case of perinatal arterial ischemic stroke, lower extremity arterial and inferior vena-caval thrombosis. Our patient was treated with unfractionated heparin for 10 days then switched to low molecular heparin to complete 6 months of therapy. The patient responded well to therapy and shows minimal signs of permanent neurologic deficits after 6 months.
文摘Pulmonary tumour thrombotic microangiopathy(PTTM)is a rare but under-recognised cause of rapidly progressive pulmonary hypertension(PH)and cor pulmonale,characterised by diffuse obstruction of small pulmonary arteries by metastatic tumour cells.These tumour emboli lead to obstructive intimal proliferation and in situ thrombosis within the pulmonary vasculature,further compromising the overall permeability of the pulmonary vascular bed and exacerbating PH.[1]The clinical and imaging manifestations of PTTM often overlap with those of other causes of PH,including chronic thromboembolic PH,pulmonary veno-occlusive disease and pulmonary capillary haemangiomatosis,often leading to diagnostic delays.
文摘s To determine the relative value of transesophageal echocardiography (TEE) and tr ansthoracic echocardiography (TTE) in exploring the potential embolic source (PE S) in heart and aortic arch and to study the clinical significance of aortic arc h athersclerosis (AAA) Methods Forty nine patients with cerebral embolism were included in this study TEE an d TTE were used to evaluate the potential source of emboli in aortic arch, heart and duplex in the carotid artery An atherosclerotic lesion of the aortic arch was defined as normal, mild plaque, moderate plaque, and protruding plaque or m obile plaque Results Of the 49 patients, 31(63%) patients showed evidence of AAA: 7 (14 1%) patients were mild, 9 (18 4%) were moderate and 15 (30 6%) were severe In those 15 p atients, 11 had neither severe ICAA nor heart disease Thirty three patients h ad internal carotid arterial atherosclerosis (ICAA) The potential sources of e mbolization of heart and aortic arch is 48 98% by TEE, but only 18 4% by TTE; 9 patients had heart disease Age and ICAA were significantly correlated with A AA Conclusion At present, TEE is a better method for exploring atherosclerotic lesions in the thoracic aorta AAA is an important potential source of cerebral embolic stroke
基金The prospective observational study was approved by the NHS Ethics Committee(MREC number 10/H1206/77)Research&Development Department(R&D C1080610).
文摘Introduction:ABCD^(2) risk score and cerebral microemboli detected by transcranial Doppler(TCD)have been separately shown to the predict risk of recurrent acute stroke.We studied whether ABCD2 risk score predicts cerebral microemboli in patients with hyper-acute symptomatic carotid artery stenosis.Participants and methods:We studied 206 patients presenting within 2 weeks of transient ischaemic attack or minor stroke and found to have critical carotid artery stenosis(≥50% ).86 patients(age 70±1(SEM:years),58 men,83 Caucasian)had evidence of microemboli;72(84% )of these underwent carotid endarterectomy(CEA).120 patients(age 72±1 years,91 men,113 Caucasian)did not have microemboli detected;102(85% )of these underwent CEA.Data were analysed using X2 and Mann–Whitney U tests and receiver operating characteristic(ROC)curves.Results:140/206(68% :95% CI 61.63 to 74.37)patients with hyper-acute symptomatic critical carotid stenosis had an ABCD2 risk score≥4.There was no significant difference in the NICE red flag criterion for early assessment(ABCD^(2) risk score≥4)for patients with cerebral microemboli versus those without microemboli(59/86 vs 81/120 patients:OR 1.05 ABCD2 risk score≥4(95% CI 0.58 to 1.90,p=0.867)).The ABCD2 risk score was<4 in 27 of 86(31% :95% CI 21 to 41)embolising patients and in 39 of 120(31% :95% CI 23 to 39)without cerebral microemboli.After adjusting for pre-neurological event antiplatelet treatment(APT),area under the curve(AUC)of ROC for ABCD2 risk score showed no prediction of cerebral microemboli(no pre-event APT,n=57:AUC 0.45(95% CI 0.29 to 0.60,p=0.531);preevent APT,n=147:AUC 0.51(95% CI 0.42 to 0.60,p=0.804)).Conclusions:The ABCD2 score did not predict the presence of cerebral microemboli or carotid disease in over one-quarter of patients with symptomatic critical carotid artery stenosis.On the basis of NICE guidelines(refer early if ABCD2≥4),assessment of high stroke risk based on ABCD2 scoring may lead to inappropriate delay in urgent treatment in many patients.
基金supported by the Natural Science Foundation of China(10974035)the Program of Shanghai Subject Chief Scientist(10XD1400600)
文摘The purpose of this study is to establish the simulation model of the gas emboli by analyzing reasons for features of gas emboli Doppler ultrasound signals. It is useful for the further classification of the solid emboli and gas emboli. First, the model of the radiation force and the drag force is used to calculate forces acting on the gas emboli. Second, the acceleration of the gas emboli is calculated in both the radial direction and the axial direction of the vessel, which is used to calculate the trajectory of the gas emboli in the vessel. Finally, the computer simulation model is established for the gas emboli. Doppler ultrasound signals of the gas emboli and the solid emboli are generated in the simulation experiment. Experimental results show that compared with the solid emboli, the gas emboli acted by the radiation force and the drag force will result in the frequency-domain broaden in the Doppler spectrogram. When the gas emboli circulate from the low speed area to the high speed one and then from the high speed area back to the low speed one, a ＂V＂ shape will be shown in the spectrogram of gas emboli signals. When the gas emboli circulate from the low speed area to the high speed one or from the high speed area to the low speed one, a diagonal shape will be shown for gas emboli signals. It is also shown that features of simulated gas emboli signals match with those of gas emboli signals sampled from clinic. All demonstrate that the simulation method of the gas emboli is reasonable.
文摘Objective To summarize and analyze the morphology and distribution of embolus in patients suspected acute pulmonary embolism. Methods The CT pulmonary angiography(CTPA) imagings of 279 patients suspected acute pulmonary embolism were analyzed retrospectively
文摘Objective To investigate the expression of tissue factor and explore its clinical significances in pulmonary artery after acute pulmonary thromboembolism.Methods Thirty-four Japanese white rabbits(LevelⅡanimals)were randomly(random number)assigned into four groups:group A(specimen of pulmonary artery was taken 3 hours
文摘Although the perioperative bleeding complications and the major side effects of blood transfusion have always been the primary concern in liver transplantation(OLT),the possible cohesion of an underestimated intrinsic hypercoagulative state during and after the transplant procedure may pose a major threat to both patient and graft survival.Thromboembolism during OLT is characterized not only by a complex aetiology,but also by unpredictable onset and evolution of the disease.The initiation of a procoagulant process may be triggered by various factors,such as inflammation,venous stasis,ischemia-reperfusion injury,vascular clamping,anatomical and technical abnormalities,genetic factors,deficiency of profibrinolytic activity,and platelet activation.The involvement of the arterial system,intracardiac thrombosis,pulmonary emboli,portal vein thrombosis,and deep vein thrombosis,are among the most serious thrombotic events in the perioperative period.The rapid detection of occlusive vascular events is of paramount importance as it heavily influences the prognosis,particularly when these events occur intraoperatively or early after OLT.Regardless of the lack of studies and guidelines on anticoagulant prophylaxis in this setting,many institutions recommend such an approach especially in the subset of patients at high risk.However,the decision of when,how and in what doses to use the various chemical anticoagulants is still a difficult task,since there is no common consensus,even for highrisk cases.The risk of postoperative thromboembolism causing severe hemodynamic events,or even loss of graft function,must be weighed and compared with the risk of an important bleeding.In this article we briefly review the risk factors and the possible predictors of major thrombotic complications occurringin the perioperative period,as well as their incidence and clinical features.Moreover,the indications to pharmacological prophylaxis and the current treatment strategies are also summarized.
