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Objective:To explore the pathological characteristics and outcomes of elderly patients with community acquired pneumonia (CAP) accompanied by coronavirus disease 2019 (COVID-19).Methods:The diagnosis and treatment process of one elderly patient with CAP accompanied by COVID-19 who was admitted to COVID-19 Treatment Center of Liaoning Province on February 7, 2020 were reviewed. The experience of treatment by analyzing the characteristics of such type of patients during diagnosis and treatment were summarized.Results:A female patient, aged 79 years ald, was admitted to the Center with following features: fever, dry cough, fatigue with dyspnea, scattered moist rales in both lungs, oxygenation index (PaCO 2/FiO 2) of 95 mmHg (1 mmHg = 0.133 kPa), and diffuse interstitial pneumonia in both lungs indicated by chest CT, of which the majority were ground glass-like and fibrous lesions. It was confirmed to be consistent with the feature of severe COVID-19 cases. The patient was successfully cured one month later following anti-inflammatory, anti-viral and high-flow oxygen therapies, homeostasis maintenance of the body, psychological counseling, etc. Accordingly, the treatment experience in CAP combined with COVID-19 in the elderly patients was summarized as follows. In respiratory system, the timing of high-flow oxygen therapy and mechanical ventilation should be seized. As for anti-inflammatory and antiviral therapy, attention should be paid to the treatment of CAP as well as antiviral therapy and symptomatic and supportive therapy. With the progression of the disease, the production of drug-resistant bacteria and the possibility of fungal infection should be paid attention to. For the circulatory system, we should pay attention to the stability of fluid volume and internal environment, and strengthen hemodynamic monitoring and bedside ultrasound to evaluate the cardiovascular capacity-load. In the aspect of the immune system, the selection of the application time of immune-enhancers and glucocorticoids should be paid attention to. In terms of enteral nutrition, early low-fat and high-protein diet is conducive to the recovery of intestinal function and the prevention of bacterial translocation. In addition to the protection of the function of important organs, therapies such as reasonable sedation and psychological intervention should also be used. Conclusions:Elderly patients with CAP accompanied by COVID-19 have complicated conditions and high degree of difficulty in treatment. Comprehensive evaluation of the disease as well as synthetic and effective intervention are the key factors of successful treatment of such patients.
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<p><b>BACKGROUND</b>It is known that the main role of D-dimer has been as an exclusionary test in patients with suspected venous thromboembolism. However, the D-dimer is increasingly beginning to find clinical utility as a marker in the evaluation of the extent of the embolic disease. The aim of the study was to determine whether D-dimer levels predict the radiological markers of pulmonary embolism (PE) severity using Mastora score.</p><p><b>METHODS</b>This prospective study involved 69 patients with acute PE proved by computed tomography pulmonary angiography (CTPA). The D-dimer level was noted. A pulmonary artery obstruction index (PAOI; Mastora score) ≥ 21.3% indicated severe obstruction of PE. A right ventricle/left ventricle (RV/LV) ratio >0.9 indicated RV dysfunction.</p><p><b>RESULTS</b>The median D-dimer level and PAOI were 765 µg/L (95% CI: 750-1 205 µg/L) and 16.77% (95% CI: 16.32%-23.06%), respectively. The D-dimer level was positively correlated with PAOI (r = 0.417, P < 0.000 1). PAOI ≥ 21.3% was associated with high D-dimer levels (median, 993 µg/L (95% CI: 856-1 841 µg/L), Z = -2.991, P = 0.003). The D-dimer level was correlated with the RV/LV ratio (r = 0.272, P = 0.024). RV/LV ratios >0.9 were associated with high D-dimer levels (median, 880 µg/L (95% CI: 764-1 360 µg/L), Z = -2.070, P = 0.038). PAOI was positively correlated with the RV/LV ratio (r = 0.390, P = 0.001). After three months, both the PAOI and D-dimer levels decreased (Z = -7.009, P < 0.000 1; Z = -6.976, P < 0.000 1, respectively).</p><p><b>CONCLUSION</b>D-dimer levels are positively correlated with PE burden and right ventricle dysfunction on CTPA, and can help monitor the therapeutic response.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Angiography , Fibrin Fibrinogen Degradation Products , Metabolism , Prospective Studies , Pulmonary Artery , Pathology , Pulmonary Embolism , Diagnostic Imaging , Metabolism , Pathology , Tomography, X-Ray Computed , Ventricular Dysfunction, Right , Diagnostic Imaging , Metabolism , PathologyABSTRACT
Objective To study the regional anatomy of the cavernous sinus for skull base surgery.Methods Continuous thin sections on coronary plane were performed with freezing milling technique on an head specimen from March 2008 to November 2011.After segmenting,labeling and extracting in a seraial sections,we finished the three dimensional reconstruction of the cavernous sinus.Results Three hundred and ninety thin coronary sections were obtained.The related structures were described in six typical sections.The cavernous sinuses were located on each side of the sphenoid sella.The sinus connects to the superior orbital fissure below and lateral to the anterior clinoid process,opens into the basilar sinuses lateral to the dorsum sellae.The four main spaces within the sinus,identified by their relation to the carotid artery,were the medial,the anteroinferior,the posterosuperior compartments and the lateral space.The four spaces were located differnently and communicate with each others in three dimensional images.Conclusion Combination of coronary section anatomy and three dimensional reconstruction can display the anatomical characters of the s cavernous sinus.The 3D models are video films that continuously and dynamically display anatomic structures in 3D space at different velocities.
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Objective To emphasize the importance of the early diagnosis and treatment of Lemierre syndrome caused by Arcanobacterium haemolyticum.Method A case of Lemierre syndrome caused by Arcanobacterium haemolyticum and three similar reported cases were reviewed.Results A man complained of fever with a sore throat,and examination found an enlarged left tonsil with prominent exudate,normal blood routine test and chest radiograph.Although the patient received the treatment of penicillin G and azithromycin,his condition worsened.Blood test showed white blood cell count 13.59 × 109/L (neutrophils 0.933),platelet count 7.4 × 109/L,TBil 54.3 mmol/L,DBil 28.3 mmol/L,AST 127 IU/L,ALT 82 IU/L,serum albumin 19.3 g/L with the development of the conditions.Blood cultures grew Arcanobacterium haemolyticum and the piperacillin-tazobactam was administered until fever was controlled.In addition,anticoagulation was administered when the thrombus was confirmed in the left internal jugular vein.Two follow-up clinic visits over the following 4 months were unremarkable.Besides three similar cases reported,four patients were male,and the ages ranged from 19 to 54 years.The chief complaints were sore throat and fever (4/4),with neck pain (4/4).Physical examinations found pharyngitis (2/4),exudate or abscess in the tonsillar crypt (2/4),maculopapular rashes (2/4).Laboratory results showed leukocytosis and thrombocytopaenia (4/4),acute cholestatic liver dysfunction (3/4),acute renal failure (2/4),acute respiratory failure (1/4).The first chest radiographs were normal at the onset,but chest radiography features included peripheral nodules and cavitation (3/4),focal or wedge-shaped lesions (1/4),pleural effusion (1/4) with the development of the conditions.Blood culture proved that there was only growth of Arcanobacterium haemolyticum (2/4),both Fusobacterium necrophorum and Arcanobacterium haemolyticum were found (2/4).Amoxicillin/clavulanic acid or piperacillin/tazobactam was administered (4/4).Neck CT proved internal jugular vein thrombosis (3/4) and anticoagulation was administered (3/4).All patients recovered and no one died.Conclusions The characters of Lemierre syndrome include primary oropharynx infection,septicaemia,septic or embolic phlebitis of jugular vein,and metastatic abscess.Early recognition and aggressive intravenous broad-spectrum antibiotics are critical to reduce mortality.
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Objective To study the developmental process of the region of basal nuclei of postmortem fetuses by 3.0 T and 7.0 T MRI.Methods One hundred and thirty-one postmortem fetuses of 14 to 40 weeks of gestational age(GA)were scanned by 3.0 T MR,of which 11 fetuses of 14-27 weeks of GA were chosen and scanned by 7.0 T MR. The time when the structures in the region of basal nuclei could be detected and the changes of MR signal intensity were analyzed for MRI of different Tesla.Results On 3.0 T MRI.the dorsal thalamus could be delineated as early as 14 weeks of GA. The germinal matrix, caudate nucleus,and putamen could be visualized as early as 15 weeks of GA. The globus pallidus could be described as early as 18 weeks of GA.and the internal capsule and external capsule could be shown as early as 20 weeks of GA. The signal of the caudate nucleus during 15-30 weeks of GA was relatively hypointense on T1WI and hyperintense on T2WI.but during 31-40 weeks of GA, it was relatively hyperintense on T1WI and hypointense on T2WI. The putamen had a relatively high signal intensity on T1WI and low signal intemity on T1WI during 15-17 weeks of GA, and it appeared patchy during 18-25 weeks of GA,then it had a relatively low signal intensity on T1WI and high signal intensity on T2WI during 26-30 weeks of GA, and during 31-40 weeks of GA,its signal intensity was relatively high on T1WI and low on T2WI.The globus pallidus had a relatively high signal intensity on T1WI and low signal intensity on T2WI during 20-40 weeks of GA Compared to the 3.0 T MRI,the T2 images of 7.0 T MRl were more clear,and most structures in the region of basal nuclei could be clearly displayed as early as 16 weeks of GA.such as the germinal matrix,caudate nucleus,dorsal thalamus,putamen,globus pallidus,internal capsule,and external capsule.The claustrum could be delineated as early as 18 weeks of GA on 7.0 T MRI. Conclusions 3.0 T MRI could show the developmental process of the region of basal nuclei well,but the T2 images of 7.0 TMRl were comparatively better.
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Objective To study the capability of high field MRI in demonstrating the post-mortem fetal brains at different gestational age(GA).Methods One hundred and eight post-mortem fetal brains of 14-40 weeks GA were evaluated by 3.0 T MRI. Eleven brains of 14 to 27 weeks GA with good 3.0 T MRI images were chosen and scanned by 7.0 T MRI. The developing sulci, layered structures of fetal cerebral cortex and basal nuclei were evaluated on MRI of different Tesla(3.0 T and 7.0 T)and their results analyzed. Results On T_1 WI of 3.0 T MRI, the layered structures of fetal cerebral cortex were present at 14 weeks GA, the sulci were more accurately identified after 16 weeks GA. The basal nuclei were clearly distinguishable after 20 weeks GA. and these structures were better visualized as the GA increased. On T_2WI of 7.0 T MRI, the sulei, layered structures of fetal cerebral cortex and basal nuclei were shown more clearly at the same GA when compared to 3.0 T, especially the sulci at the early developmental stages. Conclusions T_1 WI of 3.0 T MRI could show the developing structures of post-mortem fetal brain well, but the T_2 WI of 7.0 T MRI were comparatively better.
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OBJECTIVE To demonstrate a rare case of hepatic abscess caused by amebiasis and to discuss the reason of misdiagnosis.METHODS A fifty years old male patient with amebic liver abscess,misdiagnosed as hepatic(carcinoma),was studied.RESULTS The patient with a huge hepatic mass lesion was misdiagnosed as hepatic(carcinoma) and received interventional therapy four times within 13 months.Amebae were found in the(aspiration) of the lesion and in patient′s sputum.The temperature of the patient returned to normal range after(antibiotics) and anti-amebic therapy.CONCLUSIONS Amebic abscess is a clinically rare encountered pathology now.When to make the diagnosis,hepatic carcinoma should be carefully considered and differentiated.
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<p><b>OBJECTIVE</b>To study thrombosis and its significance after acute experimental pulmonary thromboembolism.</p><p><b>METHODS</b>The acute pulmonary thromboembolism (PTE) model of rabbits was established by intravenous injection of autologous blood clots (0.04 g/kg) which were stabilized in temperature-controlled (70 degrees C) distilled water for 10 min. The process of thrombosis was observed grossly and microscopically. The Quick's method was used to examine the coagulability of blood and radioimmunoassay was employed to measure the level of plasma thromboxane A(2) and endothelin.</p><p><b>RESULTS</b>Thrombotic propensity was observed at 1 h, fresh thrombus started to form and the blood coagulation system was activated at 24 h following clots infusion. Emboli were completely or partly dissolved at 5 d and appeared to organize at both 10 d and 14 d after clots were infused. Venous plasma thromboxane A(2) concentration began to increase at 5 min (2489.59 +/- 714.68 ng/L) and reached its maximum at 15 min (2545.46 +/- 590.58 ng/L) then declined at 60 min after clot infusion (P < 0.001, respectively, vs 626.59 +/- 510.02 ng/L of pre-clot). The level of endothelin in both arterial and venous blood increased at 5 d post-clot infusion (840.74 +/- 154.19 ng/L, 230.35 +/- 52.39 ng/L, respectively) compared to the one before infusion (602.66 +/- 453.26 ng/L, 148.01 +/- 53.28 ng/L, respectively, P < 0.05).</p><p><b>CONCLUSIONS</b>Thrombosis occurs after autologous-blood-clot-induced PTE. The interactions between thrombus formation, fibrinolysis and organization determines the consequences of emboli. Abnormalities of endothelin metabolism and the increment of thromboxane A(2) may play an important role in PTE.</p>
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Animals , Rabbits , Blood Coagulation , Endothelins , Blood , Lung , Pathology , Pulmonary Embolism , Blood , Pathology , Thrombosis , Pathology , Thromboxane B2 , BloodABSTRACT
Objective To evaluate the effectiveness of pulmonary embolectomy by cathether for the treatment of acute pulmonary embolism. Methods 38 cases were diagnosed pulmonary embolism by pulmonary angiography, treated by thrombus fragmentation and suction by cathethers, and local fibrinolysis. The symptoms, PaO 2, PAPM and pulmonary arteries were observed after the procedure. Results 36 patients survived and showed clinical improvement with significant decrease in PaPm and increase in PaO 2( P
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Pulmonary embolism(PE)is a relatively common cardiovascular emergency.Haemodynamic instability is the characteristics of massive pulmonary embolism,with a mortality as high as 20%.The goals of PE treatment are to remove the thromboembolic obstruction rapidly,exert beneficial effects on haemodynamic parameters and save the lives of patients.Haemodynamic and respiratory support is of vital importance in some critically ill patients with PE.The basic treatment is anticoagulation,the methods of which are different for PE during pregnancy,among cancer patients,with right heart thrombi and with heparin-induced thrombocytopenia.