Zheng Ziyu

GW24-e3511 Efficacy and prognosis of low molecular weight heparin (LMWH) in the treatment for the patients with chronic cor pulmonale during acute attack

Objectives To investigate the efficacy and prognosis of low molecular weight heparin (LMWH) in the treatment for the patients with chronic cor pulmonale during acute attack. Methods 320 cases patients with chronic cor pulmonale during acute attack, were at random divided into study group (167 cases) and control group (153 cases) all the patients in two groups were given the same routine treatments such as anti-infection, expectorant, relieving spasm, balancing hydro-electrolytic disorder, low flow oxygen inhalation, and conventional digitals, diuretics, vasodilators therapy. In study group, besides routine treatment, low molecular weight heparin (LMWH) was given. compared clinical features, laboratory results in the two groups before and after the treatment. We followed up these cases during 90 days after treatment, the patients in both groups were observed for comparison of the clinical effect, major adverse events rate, complication, stroke and the death of 90 days. Results Clinical features, laboratory results in study group were markedly improved after the treatment than those in control group (91% VS 82%) (P < 0.05), the patient in control group was associated with an increase numbers of hospitalisation and shorter time interval for readmission for the patients with chronic cor pulmonale during acute attack (P < 0.05). Morbidity from brain stroke is more frequent in control group than those in study group, 11/167 VS 3/153 (P < 0.05). Conclusions Low molecular weight heparin (LMWH) was effective to the patients with chronic cor pulmonale during acute attack.

GW24-e3575 The clinical observation of Atrial Fibrillation on systolic dysfunction of Congestive Heart Failure Patients

Objectives To explore the prevalence, distribution and prognosis of Atrial fibrillation on systolic dysfunction of congestive heart failure (CHF) in hospitalised patients. Methods We reviewed the medical records of 462 unselected consecutive patients with heart failure who were admitted to our Hospital between 1, 2009 to 1, 2010, patients were categorised as having systolic dysfunction with LVEF < 50% based on the results of echocardiography. We compared the 1 years clinical outcomes (stroke, myocardial infarction, unstable angina and cardiovascular death). Results AF was documented in 166 patients (36%), including 87 patients (19%) at baseline and 79 patients (17%) during subsequent follow-up with systolic dysfunction of CHF. The occurrence of AF in patients of heart failure with LVEF < 50% was associated with an increase numbers of hospitalisation and shorter time interval for readmission for CHF(P < 0.05). Conclusions AF occurred in up to 1/3 patients with systolic dysfunction of CHF. The occurrence of AF did not affect the 1 year outcomes in these patients, but increased their numbers of hospitalisation for CHF. Therefore treatment and prevention of AF have important implication in the management of patients with systolic dysfunction of CHF.

GW24-e3147 Management of Myasthenic Crisis and risk factors for prolonged mechanical ventilation

Objectives To evaluate the management of myasthenic crisis (MC) and to analyse the risk factors for prolonged mechanical ventilation. Methods Retrospective review of consecutive patients admitted for MC between January 1994 and December 2011 in the First Affiliated Hospital of Sun Yat-sen University. Risk factors for prolonged mechanical ventilation were analysed retrospectively by age, gender, autoimmune disease, ischemic heart disease, disease duration, precipitating factor, thymoma, pneumonia, atelectasis, high-dose corticosteroid therapy and bacteremia. Results We identified 53 episodes of MC in 38 patients. Five patients died during hospitalisation, the success rate was 90.6%. In the univariate analysis, age (P = 0.024), infectious causes (P = 0.007), concurrent atelectasis (P = 0.011), pneumonia (P = 0.027) and bacteremia (P = 0.046) were significantly related to prolonged mechanical ventilation, while age (P = 0.035), concurrent atelectasis (P = 0.042) and pneumonia (P = 0.025)were statistically significantly linked with prolonged mechanical ventilation in the multivariate analysis. Conclusions Timely opening the airway and applying appropriate mechanical ventilation is the key to successful emergency treatment for MC; plasma exchanges or intravenous immunoglobulin can markedly improve the outcome of MC; elder, concurrent atelectasis and pneumonia are the risk factors for prolonged mechanical ventilation.

VALUE OF D-DIMER FOR DETECTION OF ACUTE AORTIC DISSECTION

Objectives The purpose of this research was to assess the value of several plasma biomarkers in the detection of acute aortic dissection (AAD). Methods From 2006 to 2011, 118 consecutive patients with established AAD, 94 consecutive patients with chronic aortic aneurysms scheduled for elective surgery in our hospital and 98 normal subjects were evaluated for plasma D-dimer, C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptide (BNP). Results All AAD patients showed significantly higher elevated D-dimer values compared to both the chronic aneurysm patients as well as the normal subjects (p<0.0001); A cut-off value of 850 ng/ml was effective in distinguishing AAD from the other two groups, with a sensitivity of 90% and a specificity of 62%. Plasma CRP and BNP values in AAD or chronic aortic aneurysms were much higher than in the normal controls (p<0.0001 and p=0.0016, respectively), but these parameters did not show significant differences between AAD and chronic aortic aneurysms (p=0.32). Conclusions D-dimer can be used as a ‘rule-out’ test in patients with suspected AAD and, unlike CRP and BNP, it seems could help making a differential diagnosis between AAD and chronic aortic aneurysms.

PAINLESS AORTIC DISSECTION WITH INITIAL SYMPTOMS OF PARAPLEGIA AND ACUTE RENAL FAILURE: A CASE REPORT

Objectives A 67-year-old man was transferred to the Emergency Department of our hospital for emergent evaluation of paraplegia and oliguria, from the local hospital of the nearby town, where he was admitted complaining from sudden, painless, progressive bilateral leg weakness and oliguria 4 days earlier. He gave no history of hypertension, diabetes mellitus or hyperlipidaemia, and had a negative family history of aortic diseases. On initial evaluation, the patient had a blood pressure of 131/71 mm Hg. His oral temperature was 36.4°C, pulse rate was 82 beats/min and respiratory rate was 20/min. He presented complete flaccid paraplegia with oliguria (urinary output <400 ml/d) and urinary retention, loss of pain and temperature sensation, vibration and position sense below the TH7 level bilaterally. Other general physical examinations were unremarkable. Laboratory tests showed a white blood cell count of 19.80×109/l, haemoglobin concentration of 109 g/l, blood urea nitrogen concentration of 50 mmol/l, blood creatinine concentration of 820 µmol/l, sodium concentration of 114 mmol/l, and potassium concentration of 4.6 mmol/l. The liver function tests were normal and other observations were unremarkable. Later thoracic and lumbar MRI revealed swelling of thoracolumbar spinal cord, with no enhancement on T1-weighted images (wi) and increased signal on T2-wi at the TH9-TH12 levels, suggesting cord ischaemia. At the same MR sequences, the double lumen of the descending aorta involving bilateral renal arteries indicated dissection in both sagittal and axial images. The diagnosis of Stanford type B acute aortic dissection was confirmed. When patients present with or develop signs and symptoms of paraplegia without obvious cause, aortic dissection should be considered, even without the presence of characteristic thoracic pain. Methods A 67-year-old man was transferred to the Emergency Department of our hospital for emergent evaluation of paraplegia and oliguria, from the local hospital of the nearby town, where he was admitted complaining from sudden, painless, progressive bilateral leg weakness and oliguria 4 days earlier. He gave no history of hypertension, diabetes mellitus or hyperlipidaemia, and had a negative family history of aortic diseases. On initial evaluation, the patient had a blood pressure of 131/71 mm Hg. His oral temperature was 36.4°C, pulse rate was 82 beats/min and respiratory rate was 20/min. He presented complete flaccid paraplegia with oliguria (urinary output<400 ml/d) and urinary retention, loss of pain and temperature sensation, vibration and position sense below the TH7 level bilaterally. Other general physical examinations were unremarkable. Laboratory tests showed a white blood cell count of 19.80×109/l, haemoglobin concentration of 109 g/l, blood urea nitrogen concentration of 50 mmol/l, blood creatinine concentration of 820 µmol/l, sodium concentration of 114 mmol/l, and potassium concentration of 4.6 mmol/l. The liver function tests were normal and other observations were unremarkable. Later thoracic and lumbar MRI revealed swelling of thoracolumbar spinal cord, with no enhancement on T1-weighted images (wi) and increased signal on T2-wi at the TH9-TH12 levels, suggesting cord ischaemia. At the same MR sequences, the double lumen of the descending aorta involving bilateral renal arteries indicated dissection in both sagittal and axial images. The diagnosis of Stanford type B acute aortic dissection was confirmed. When patients present with or develop signs and symptoms of paraplegia without obvious cause, aortic dissection should be considered, even without the presence of characteristic thoracic pain. Results A 67-year-old man was transferred to the Emergency Department of our hospital for emergent evaluation of paraplegia and oliguria, from the local hospital of the nearby town, where he was admitted complaining from sudden, painless, progressive bilateral leg weakness and oliguria 4 days earlier. He gave no history of hypertension, diabetes mellitus or hyperlipidaemia, and had a negative family history of aortic diseases. On initial evaluation, the patient had a blood pressure of 131/71 mm Hg. His oral temperature was 36.4°C, pulse rate was 82 beats/min and respiratory rate was 20/min. He presented complete flaccid paraplegia with oliguria (urinary output <400 ml/d) and urinary retention, loss of pain and temperature sensation, vibration and position sense below the TH7 level bilaterally. Other general physical examinations were unremarkable. Laboratory tests showed a white blood cell count of 19.80×109/l, haemoglobin concentration of 109 g/l, blood urea nitrogen concentration of 50 mmol/l, blood creatinine concentration of 820 µmol/l, sodium concentration of 114 mmol/l, and potassium concentration of 4.6 mmol/l. The liver function tests were normal and other observations were unremarkable. Later thoracic and lumbar MRI revealed swelling of thoracolumbar spinal cord, with no enhancement on T1-weighted images (wi) and increased signal on T2-wi at the TH9-TH12 levels, suggesting cord ischaemia. At the same MR sequences, the double lumen of the descending aorta involving bilateral renal arteries indicated dissection in both sagittal and axial images. The diagnosis of Stanford type B acute aortic dissection was confirmed. When patients present with or develop signs and symptoms of paraplegia without obvious cause, aortic dissection should be considered, even without the presence of characteristic thoracic pain. Conclusions A 67-year-old man was transferred to the Emergency Department of our hospital for emergent evaluation of paraplegia and oliguria, from the local hospital of the nearby town, where he was admitted complaining from sudden, painless, progressive bilateral leg weakness and oliguria 4 days earlier. He gave no history of hypertension, diabetes mellitus or hyperlipidaemia, and had a negative family history of aortic diseases. On initial evaluation, the patient had a blood pressure of 131/71 mm Hg. His oral temperature was 36.4°C, pulse rate was 82 beats/min and respiratory rate was 20/min. He presented complete flaccid paraplegia with oliguria (urinary output <400 ml/d) and urinary retention, loss of pain and temperature sensation, vibration and position sense below the TH7 level bilaterally. Other general physical examinations were unremarkable. Laboratory tests showed a white blood cell count of 19.80×109/l, haemoglobin concentration of 109 g/l, blood urea nitrogen concentration of 50 mmol/l, blood creatinine concentration of 820 µmol/l, sodium concentration of 114 mmol/l, and potassium concentration of 4.6 mmol/l. The liver function tests were normal and other observations were unremarkable. Later thoracic and lumbar MRI revealed swelling of thoracolumbar spinal cord, with no enhancement on T1-weighted images (wi) and increased signal on T2-wi at the TH9-TH12 levels, suggesting cord ischaemia. At the same MR sequences, the double lumen of the descending aorta involving bilateral renal arteries indicated dissection in both sagittal and axial images. The diagnosis of Stanford type B acute aortic dissection was confirmed. When patients present with or develop signs and symptoms of paraplegia without obvious cause, aortic dissection should be considered, even without the presence of characteristic thoracic pain.