The clinical value of the decfion of percentage of pulmonary perfusion defect scores for pulmonary embolism / 中国基层医药

Objective To investigate the clinical value of the decfion of percentage of pulmonary perfusion defect score (PPDS％) in patients with pulmonary embolism (PE).Methods A retrospective study was carried out on PPDs％ data of patients(n =36) with clinical confirmed PE.The patients were divided into three levels:low (PPDS％ ＜30％),medial (30％ ≤PPDS％ ＜50％) and high (PPDS％ ≥50％) risk groups,according to the standard of PPDs％ diagnosis.the PPDS％ and the incidence rate of the clinical adverse events were compared in mild,moderate and severe risk PE.The therapeutic results were compared with the PPDS％ changes.Results The mild,moderate and severe risk patients with PE were 15 cases,13 cases and 8 cases respectively,according to the standard of PPDS％ diagnosis.16 cases,12 cases and 8 cases respectively,according to the standard of 2008 ESC APE diagnosis and treatment guidelines.The uniform rate was 94.4％ for two methods,the uniform rate was 100.0％ in which high risk of PE.The PPDS％ of PE was (46.2 ± 4.6) ％ before treatment.The data was significantly higher than that post treatment (31.6％ ± 1.8％) (t =17.38,P ＜ 0.01).The scores of low,medial and high risk patients were (25.9 ± 3.9) ％,(45.6 ± 4.3) ％ and (58.4 ± 4.9) ％ (t =6.18,P ＜ 0.01),respectively.The mild,moderate and severe risk PE according to the PPDS％ standard with clinical adverse events for were 1 cases (6.5％),3 cases (23.0％) and 5 cases (62.5 ％) respectively,with a significant difference (x2 =8.71,P ＜ 0.05).Conclusion PPDS％ could be used as an important reference index for risk stratification of diagnosis,evaluating therapeutic efficiency and predicting the prognosis in patients with PE.

The clinical evalution of the upper extremital vascular running in the patients after peripheral vascular surgery by Na99mTcO4 trace imaging / 中国基层医药

Objective To evaluate the clinical value of the upper extremital artery supply and vein running back in the patients after peripheral vascular surgery by Na99mTcO4 trace imaging(TTI).Methods SPECT static imaging was performed on 36 patients after peripheral vascular surgery in vein injecting Na99mTcO4 740 MBq 5min.The radioactivity uptake of operated limb(finger)/normal limb(finger) ratio(T/NT) was analyzed using region of interest analysis.0,Ⅰ,Ⅱand Ⅲ scales were classified according to their radionuclide distribution and T/NT,were divided into A,B,C and D group,respectively.Localy warming and anticontrctive therapy were only given in A and B group for 30min,routine therapy in C group,and raising operated limb (finger) and reductive pressure treatment in D group.Then,exploratory surgery was performed on 0 scales and Ⅲ scales of TTI again.Results A,B,C and D group were 11,7,13 and 5 patients,their T/NT was (0.142 ± 0.058),(0.384 ± 0.046),(0.794 ± 0.072) and (1.12 ±0.076),respectvely,and there were significant differences among the groups(t =2.33a,4.33b,6.90b,2.59a,5.73b,2.12a,aP ＜ 0.05,b P ＜ 0.O1) ;TTI again showed:there were 7 cases of 0 scales (arterial thrombosis was confirmed by exploratory surgery) and 4 cases of Ⅰ scales in A group,3 cases of Ⅰ scales and 4 cases of Ⅱ scales in B group,all 13 cases of Ⅱ scales in C group,4 cases of Ⅱ scales and 1 case of Ⅲ scales(vein thrombosis was confirmed by exploratory surgery) in D group.Conclusion TTI could play an important role in economical,simple and notraumatic diagnosing the extremital artery supply and vein running back in the patients after peripheral vascular surgery.

The correlation between hypothyroidism incidence and thyroglobulin antibody, thyroid peroxidase antibody in Graves disease after 131Ⅰ therapy / 中国医师进修杂志

ObjectiveTo investigate the correlation between serum levels ofthyroglobulin antibody (TGAb),thyroid peroxidase antibody (TPOAb) and hypothyroidism incidence in Graves disease after 131Ⅰ therapy.MethodsThree hundred and twenty-five patients with Graves disease whose TGAb and TPOAb were negative before treatment were selected.Serum levels of FT3,FT4,TSH,TGAb and TPOAb were measured at the 3rd,6th,12th and 18th month after treatment respectively.All cases were divided into positive group and negative group according to the serum levels of TGAb and TPOAb at the 18th month after 131Ⅰ treatment.The hypothyroidism incidences of two groups were compared.ResultsThere were 271 cases in negative group and 54 cases in positive group.The hypothyroidism incidence was 7.4％(24/325),and the incidence of negative group was 3.0％ (8/271),while the incidence of positive group was 29.6％ (16/54).There was significant difference between two groups(P ＜ 0.05).ConclusionsHypothyroidism incidence of Graves disease after 131Ⅰ therapy has obvious correlation with the serum levels of TGAb and TPOAb.Dynamic observation of the serum levels of TGAb and TPOAb in Graves disease after 131Ⅰ therapy has important significance for clinical guiding and prognosis judgement.

Application value of percentage of pulmonary perfusion defect scores in predicting risk stratification of acute pulmonary embolism / 中国医师杂志

Objective To investigate the clinical value of percentage of pulmonary perfusion defect score ( PPDs％ ) for risk stratification and prognosis evaluation in patients with acute pulmonary embolism (APE).Methods A retrospective study was carried out on PPDs％ data of patients( n =21 ) with confirmed APE from January 2001 to December 2008.The patients were divided into three levels,low( n =10),medial( n =7) and high risk groups( n =4),according to 2008 ESC APE diagnosis and treatment guidelines.The reference index in predicting risk stratification by PPDs％ was ascertained.34 patients with confirmed APE were divided into three levels ( mild,moderate and severe risk levels) according to the standard of PPDS％ diagnosis from January 2009 to June 2011.A prospective study on the incidence rate of the clinical adverse events was performed.Results The PPDs％ of low,medial and high risk levels according to 2008 ESC guidelines were (25.94 ± 3.95 ) ％,(45.63 ± 4.38 ) ％ and ( 58.42 ± 4.96 ) ％ respectively,with a significant difference ( t ≥4.755,P ＜ 0.01 ).The standard of PPDS％ diagnosis for risk stratification was confirmed in APE:low risk levels:PPDs％ ＜ 30％,moderate:30％ ≤ PPDs％ ＜50％,and high:PPDs％ ≥50％.The mild,moderate and severe risk patients with APE were 17cases,11cases and 6cases respectively,according to the standard of PPDs％ diagnosis,or 15cases,13cases and 6cases respectiveldy,according to the standard of 2008 ESC guidelines.The uniform rate was 94.11％ for two methods; the uniform rate was 100.00％ in which high risk of APE.The mild,moderate and severe risk patients with APE according to the standard of PPDs％ standard with clinical adverse events for were 1case (5.89％ ),3cases (27.27％ ) and 4cases (66.67％ ) respectively,with a significant difference ( x2 =9.23,P ＜0.01 ).Conclusions PPDs％ could be used as an important reference index for risk stratification of diagnosis,selecting therapeutic programs,evaluating therapeutic efficiency and predicting the prognosis in patients with APE.

Experimental Study on Monitoring Extremital Blood Circulation in Rabbits with Replanted Limb by Na~(99m)TcO_4 Trace Imaging / 中国医师杂志

Objective To explore feasibility of monitoring the extremital arterial blood supply and venous blood circulation in rabbits with replanted limb by Na~(99m)TcO_4 trace imaging(TTI). Methods TTI was performed on 6 normal control rabbits and 30 rabbits with replanted limb at 24～36h after replantation. The radioactivity uptake ratio of replanted limb/normal limb(T/NT) was analyzed. Imaging was classified into ?,Ⅰ,Ⅱand Ⅲ scales according to the accumulation amount of extremital radionuclide. Then an exploratory operation was performed on each rabbit. Results Rabbits with ?,Ⅰ,Ⅱand Ⅳ scales had 8,6,15(including 6 normal control rabbits),and 7 animals, respectively, and their T/NT were 0.178?0.072, 0.461?0.046, 0.816?0.074, 1.14?0.086(P1.05) may serve as a qualitative and semiquantitative diagnostic standard for venous blood circulation block. Conclusion TTI was feasible in monitoring the extremital arterial blood supply and venous blood circulation in patients with replanted limb(finger).

Clinical evaluation of ~(99m)Tc-MAA imaging in patients with lower extremital posttraumatosis and postoperation / 中国医师杂志

Objective To evaluate the clinical value of ~(99m)Tc-MAA imaging in patients with lower extremital posttraumatosis and postoperation(LEPP).Methods 21 LEPP patients with clinical highly suspected acute pulmonary embolism(APE) underwent ~(99m)Tc-MAA veins imaging and pulmonary perfusion imaging(PPI).Vena caval filters were inserted and thrombolysis were given in patients with big area APE and/or iliofemoral vein thrombosis indicated by ~(99m)Tc-MAA imaging.Thrombolysis was given in patients with small area APE and/or subpopliteal vein thrombosis.PPI was reexamined after 2～4weeks` treatment.The lung segments with 100% lack of perfusion were marked 3,those with 25%～75% were marked 2,those with less than 25% were marked 1 and normal was marked 0.The therapeutic results were assessed using this marking system.Results There were 13 patients with big area APE,8 with small area APE,14 with iliofemoral vein thrombosis,and 7 with subpopliteal vein thrombosis.2 cases(9.5%) died before thromobolytic therapy.The marks were significant different before(10.2?3.8) and after(2.8?1.4) treatment(t=7.75,P