Intracranial hemorrhage (ICH) represents a severe complication of infective endocarditis (IE) and stands as a significant contributor to the poor prognosis associated with IE. Current guidelines suggested a delay of 4 weeks for cardiac surgery in patients with ICH, but these recommendations were based on insufficient clinical evidence, and recent studies have yielded different opinions. In this paper, we thoroughly reviewed relevant guidelines and their references in conjunction with 3 typical cases with IE and ICH, discussed the recommendations with controversy, and proposed a process for the management of IE with ICH.
【摘要】 目的 探讨伴有动眼神经麻痹的后交通动脉瘤的显微手术治疗效果。 方法 回顾性分析2008年1月—2010年12月采用显微外科手术治疗的伴随动眼神经麻痹的后交通动脉瘤患者52例的临床资料，观察动眼神经麻痹的恢复情况，总结临床经验。术后随访时间3～36个月，平均16个月。 结果 发病至手术时间lt;14 d患者34例，22例（64.7%）完全恢复，12例（35.3%）部分恢复。gt;14 d者18例，6例（32.3%）完全恢复，12例（67.7%）不完全恢复。不完全性麻痹15例，12例（80.0%）完全恢复，3例（20.0%）得到改善；而术前完全动眼神经麻痹的37例中，仅11例（29. 7% ）彻底恢复、26例（70. 3% ）部分恢复。 结论 早期明确诊断及尽早手术治疗，对于伴随有动眼神经麻痹的后交通动脉瘤患者的神经功能恢复极为重要。【Abstract】 Objective To explore the curative effect of microsurgical treatment for posterior communicating artery aneurysms associated with oculomotor palsy. Methods The clinical data of 52 patients with posterior communicating artery aneurysms associated with oculomotor palsy treated microsurgically from January 2008 to December 2010 were retrospectively analyzed. Recovery of oculomotor palsy was observed, and clinical experiences were summarized. Results The follow-up time ranged from 3 to 36 months with a mean period of 16 months. Among the 34 patients operated on within 14 days after the onset of oculomotor palsy, 22 (64.7%) showed complete recovery, and 12 (35.3%) partial recovery. In the 18 patients operated on more than 14 days after the onset of the disease, 6 (32.3%) showed complete recovery, and 12 (67.7%) partial recovery. Incomplete palsy occurred in 15 patients among whom 12 (80%) had complete recovery and 3 (20%) alleviation. Among the other 38 patients with complete oculomotor palsy, only 11 (29.7%) got complete recovery, and the remaining 26 (70.3%) partial recovery. Conclusion Early and positive diagnosis and treatment of patients with posterior communicating artery aneurysms associated with oculomotor palsy is of great importance to the nerve function recovery.
目的:分析以眼睑下垂为首发症状的甲亢性眼肌病的误诊原因。方法:对我院10例不典型的甲亢性眼肌病进行系统分析。结果:误诊为重症肌无力5例、颅内动脉瘤2例、颅底炎症1例、脑干腔隙性梗死1例、糖尿病性周围神经病变1例。结论:以眼睑下垂为首发症状的甲亢性眼肌病极易误诊,加强对该病的认识及尽早进行甲状腺功能检查,可有效减少误诊机会。
目的：探讨血管内Neuroform支架置入联合弹簧圈栓塞治疗颅内复杂动脉瘤的疗效、技术要点、安全性及并发症防治。方法: 研究对象为20例颅内复杂动脉瘤患者，其中颈内动脉海绵窦段4例，眼动脉段3例，后交通动脉段7例，脉络膜前动脉起始部1例，大脑中动脉M1段1例，椎动脉颅内段4例。首先将微导管置入瘤腔，然后跨瘤颈释放支架，栓塞弹簧圈。结果: 所有病例栓塞操作均顺利完成。其中致密栓塞13例，大部分栓塞7例;术后脑梗塞1例，1个月后恢复;2例弹簧圈尾端疝入载瘤动脉，均未引起相应的临床症状。随访3～24个月，平均13个月，无再出血及血栓栓塞症状。结论: 血管内支架植入联合弹簧圈治疗颅内复杂动脉瘤安全有效。
ObjectiveTo investigate the efficacy of stellate ganglion block (SGB) on postoperative palpebral edema in patients undergoing intracranial aneurysm surgery. MethodsSixty patients who were scheduled to undergo intracranial aneurysm surgery between September 2012 and Novermber 2014 were recruited, and were assigned into 2 groups randomly with 30 in each:SGB group and control group. Patients in SGB group were administered SGB by injecting 0.3% ropivacaine on the operative side under the ultrasound guidance after surgery completed, while patients in the control group received injection of saline on the operative side under the ultrasound guidance. Incidence of postoperative palpebral edema at hour 24, 48, and 72 after surgery were measured. Numerical rating scale (NRS) was used to detect the severity of uncomfortable symptoms for palpebral swelling during rest state. The severity of palpebral edema was evaluated with continuous rating scale (0-5, 0 indicated normal palpebral, and higher score indicated more serious palpebral edema). Complications related with SGB were recorded. ResultsThe overall incidence of palpebral edema at hour 24 after surgery in SGB group was lower than that in the control group (P<0.05). There was no statistically significant difference in the overall incidence of palpebral edema at hour 48 and 72 after surgery between the two groups (P>0.05). The palpebral edema rating scores of the SGB group at hour 24 after surgery were lower than those of the control group (P<0.01).The incidence of palpebral edema which was scored 3 or more at hour 24 and 48 after surgery in SGB group was lower than that in the control group (P<0.05). No statistically significant difference was found in the incidence of palpebral edema which was scored 3 or more at hour 72 after surgery between the two groups (P>0.05). No complication related with SGB was found. ConclusionSGB can safely reduce the incidence of postoperative palpebral edema in patients undergoing intracranial aneurysm surgery, and reduce the severity of palpebral edema.
ObjectiveTo summarize the experience of microsurgery in primary hospital for the posterior communicating artery aneurysms (PCOAan). MethodsThe clinical data of 48 patients with PCOAan who underwent microsurgery from January 2008 to December 2012 were retrospectively analyzed. ResultsAll the necks of aneurysms of 48 cases were successfully clipped, Acording to the Glasgow outcome score (GOS), the early curative effects were good in 36 cases (75.0%, GOS 4-5) poor in 10 cases (20.8%, GOS 2-3) and death in 3 cases (2.1%, GOS 1). After the operation was carried out, the operation time was shorten, aneurysm intraoperative rupture rate was lower, postoperative complications were lower, and the average medical expense was reduced; the difference was significant in 24 cases before and after the operation (P<0.05). ConclusionMicrosurgery for PCOAan is an effective method which should be popularized in primary hospitals.