g***r
发帖数: 285 | 1
not enough details, such as her stroke, what had caused it and what is the
treatment, how well is her diabetes controlled, and such,
if you are concerned about if she has peripheral arterial disease, you can
perform a simple screening test at home ABI, an ankle-brachial index, you
basically measure systolic pressure at brachial and ankle, and check their
ratio, |
|
g***r
发帖数: 285 | 2 very interesting, the ophthalmologists here will care less about PAD,
also, i think that tech is full of it, the main risk for arteriogram is
contrast induced renal failure, bleeding and infection and such, but the
risk of stroke is relatively small, as you'd think the arterial blood will
flow forward(toward legs/toes) and any manipulations will be difficult to
cause a stroke,
as far as diabetes controls, then it's very likely the number they are
looking at is hgb a1c, if her a1c is close to 10, |
|
g***r
发帖数: 285 | 3
not enough details, but assume he does not have wide spread disease since it
appears surgical resection was at least once considered, if his albumin and
platelet are too low, or he is too weak for invasive surgery, then you can
consider radiofrequency ablation or arterial chemoembolization, |
|
g*****j
发帖数: 1211 | 4 You description is fine. Other words that you can use are palpitation,
skipping beats, irregular heart beat, arrhythmia etc. Coronary artery
disease (冠心病) is rare in young people. A fib (atrial fibrillation, 房
颤）can manifest in this way, but is not the most common cause.
Most likely it is a benign condition, particularly if you have no
previous history or other health issues. However, you should see your
doctor to get some preliminary work-up to rule out possible pathologic
causes. |
|
n******s
发帖数: 210 | 5 As I know gingko is good for vessel spasm, esp the cerebral vascular spasm.
In cardiology, no one uses it for coronary artery spasm, CCB is DOC, so I
don't think it works well for heart disease.
For Fructose-1，6-Phosphate, it is used for provision of energy to
cardiomyocytes, typically not used for treatment, but nutrition. |
|
c********e
发帖数: 496 | 6 briefly, nausea/vomit, headache, tinnitus, shoulder pain.
and seems muscle relaxant does work for you.
so I guess this is spur of cervical spine, pressing your carotid artery (
headache, tinnitus and nausea) and nerves (shoulder muscle spasm). Xray or
CT may show us the anatomical structure.
Just my guess. |
|
c********e
发帖数: 496 | 7 胆红素5.5 umol/L （5.1-19），
结合胆红素：2.2umol/L （0-5.1）。
丙氨酸氨基转移酶：168U/L （0-40），
门冬氨酸氨基转移酶：83u/L （0-37）
碱性磷酸酶：98u/L （53-128），
伽马-谷氨酰转移酶：88u/L （7-32）；
乳酸脱氢酶：209u/L （109-245）。
No。
may be not
In some severe liver failure case, ALT AST go back to normal, bilirubin is
normal, but PT and PPT are the only and final lab test to tell what is going
on in the hepatocytes.
有一处心脏血管50%堵塞。
if not LAD or left main coronary artery, it is unnecessary.
好像是心动过缓
do you know the reason.
胆结石但说是b超没有胆囊炎。
it is normal in adult f |
|
k*****i
发帖数: 298 | 8 【 以下文字转载自 NextGeneration 讨论区 】
发信人: wym (wym), 信区: NextGeneration
标 题: (附照)宝宝原发性动脉钙化--求祝福＋帮助
发信站: BBS 未名空间站 (Tue Mar 30 15:53:05 2010, 美东)
在深圳工作的朋友的女儿，刚出生1个多月，很不幸患上这个病
原发性动脉钙化Idiopathic arterial calcification of infancy，
非常的罕见，国内甚至没有报导病例，若是在美国的朋友，有这方面的信息，希望能得到帮助，她的
邮箱是 c****[email protected] ，小扣子妈。。我们还准备了英文病例，彩超，ct等的报告单扫描件。需要的话，可以email.
病历简述：
孕35周+4早产，出生体重2.4公斤；孕24周发现妊娠糖尿病；
9天后出院，体重2.1公斤；
15天呼吸急促入院，发生心衰，代谢性酸中毒、低钠血症，有感染迹象，住院期间尿蛋白+++
24天心脏彩超被怀疑心内膜弹力纤维增生，开始持续服用地高辛，肾脏彩超右肾盏疑似沉积物；
30天转院广东省人民医院，体重1.97公斤；
34天动脉 |
|
c********e
发帖数: 496 | 9 I guess the stenosis of intracranial artery is due to atherosclerosis or
vessel spasm,
if the former, and there are dizziness, syncope, falls, and recovered in 24
hours, that's TIA. Aspirin is a must, check lipid panel, fasting blood sugar
, and further treatment depends on the location of the stenosis, severity
and other brain diseases.
if vessel spasm, some calcium channel blocker may help, and gingko
derivative meds works in some people. |
|
d*w
发帖数: 384 | 10 From the angiogram, this is much worse than Fallot's tetralogy. If surgery
is to be done, there will be multiple surgeries. The last major surgery
should be the closure of VSD, but it is very hard to determine the order of
the earlier steps (detaching right pulmonary artery from descending aorta,
connecting to right ventricular outflow tract and etc., ~5 major steps). It
is very likely computational hemodynamic simulation is required.
If you know the surgeon in the U.S., he usually will take a l |
|
l**x
发帖数: 296 | 11 Based on AJCC gastric cancer staging:
pT2 N0 Mx
侵及肌层，无淋巴结转移, 远端转移未知
It would be nice to have PET/CT scan to evaluate distant metastasis
if there is no distant metastasis, the final stage would be Stage IB
still considered fairly early.
There are a few ongoing clinical trials. The optimal
regimen for postoperative chemoradiotherapy has not yet been established.
The common chemotherapy drugs includes:
5-FU, VBL, CTX, MeCCNU, Ara-C
FYI:
Primary tumor (T)
TX: Primary tumor cannot be assessed
T0: No... 阅读全帖 |
|
c********e
发帖数: 496 | 12 64 slice CT is kind of spiral CT, more advanced than 16 slice CT.
It is pulmonary artery, instead of vein for sure.
Administration of lovenox and warfarin is reasonable, unless you have other
risk factors. Note you need to check your CBC on your next visit,to monitor
platelet level, decrease of which is one of major SEs of LMWH.
As I said, if you do not have any symptoms, it is fine. Watch out, if you
have swelling or redness on your legs, do see a doctor immediately. |
|
g*****j
发帖数: 1211 | 13 Well, apparently you had the right work up. The original ECG should
inferior ischemia (an obstruction of blood flow) at one point. It is
important to exam the coronary artery direct, which you did through CT
angiogram. The question is why you had the ischemia in the first place.
There could be many explanations, such as vasospasm, a transient stenosis
which luckily resolved spontaneously or many others including panic attack (
unlikely though to an extent of ECG changes). It will be difficu... 阅读全帖 |
|
c********e
发帖数: 496 | 14 I wonder, why not go for angiogram directly.
Briefly, more than 50% block in left main stem is significant, more than 70%
of LAD and right coronary artery should be concerned and PTCA/Stent
implantation is indicated. CT does not tell those details. In addition, more
than 3 lesions, should go for bypass instead of PTCA. |
|
w*********l
发帖数: 5144 | 15 普通球囊, restenosis rate 30%
BMS, restenosis rate 10 to 20%
DES, less than couple of percent.
late stage thrombsis is a issue, but recent DES all have good
biocompatibility
cypher is very bad, high inflamation, high metal to artery ratio, only thing
is it's the first.
boston scientific Taxus is not good either, since drug it used is cyto-toxic
, not cyto-static.
Metronic and Abbott stent all good, which used rapamycin derivative, which
is cto-static, means, not that toxic to cells.
Bill clinton use... 阅读全帖 |
|
y*****g
发帖数: 193 | 16 Nifedipine is calcium channel blocker, not good for congestive heart failure
(CHF) patient. That's why his doctor changed his antihypertensive agent from
nifedipine to lisinopril. Lisinopril is ACE inhibitor agentgood for CHF
patients. If his systolic blood pressure unable to control<140, he need go
to his cardiologist to readjust his BP meds. There is a lot of choice or
combination therapy for CHF patients.
If dyspnea on exertion reappeares, he need go to his cardiologist again too.
They need c... 阅读全帖 |
|
y*****g
发帖数: 193 | 17 possible carotid artery stenosis? check dupler study of carotid.
If hypotension is present, low blood pressure with narrowed cerebral vessels
or narrowed carotid artereis possibly leads to hypoperfussion for her brain
. There is a medication which can increase blood pressure if needed. Also
eating salty food could also increase blood pressure.
Is she anemia? and why does she have hypotension at the first place? |
|
y*****g
发帖数: 193 | 18 possible carotid artery stenosis? check dupler study of carotid.
If hypotension is present, low blood pressure with narrowed cerebral vessels
or narrowed carotid artereis possibly leads to hypoperfussion for her brain
. There is a medication which can increase blood pressure if needed. Also
eating salty food could also increase blood pressure.
Is she anemia? and why does she have hypotension at the first place? |
|
s**********8
发帖数: 25265 | 19 peripheral arterial disease? 腿毛有掉吗? |
|
f****o
发帖数: 2770 | 20 我这个人不经常运动，不知道这个是不是主要原因，现在体重180磅---BMI多少啊？
血脂偏高，胆固醇偏高-------有多高啊
抽烟喝酒么？
你别年纪轻轻就coronary artery disease啊。。。 |
|
f****o
发帖数: 2770 | 21 心肌缺血？
coronary artery disease了就要按时吃医生开的处方药
保健品如果那么有效的话，药厂就申请专利成处方药了 |
|
d********e
发帖数: 239 | 22 建议她去看医生要求做：
EKG
Echocardiogram
Stress echo or chemical stress test to rule out if she has coronary artery
problems.
另外每天查血压，早晚一次，同样的体位如座位，右臂等。看医生时将记录给医生看。
血压药要坚持吃如血压没有控制在正常范围。 |
|
l*h
发帖数: 4124 | 23 upon arrival at the hospital, immediately do a head CT with CT angiography.
was this done? which arteries are clogged?
depending on CTA, decide on whether to have thrombolytic therapy,
interventional radiology or neurovascular surgery to remove clot. was this
considered? |
|
k******e
发帖数: 8870 | 24 ☆─────────────────────────────────────☆
thinkerl (星河科技*创造无极) 于 (Sat Oct 13 10:44:15 2012, 美东) 提到:
妈妈65岁，10年来一直有高血压，但不严重，发作过两次，在国内打吊针一周左右就好
了。一直服用降压药，控制稳定。
三天前因为牙疼引起血压升高，高压180. 加量一片降压药就好了。但几天来，断断续
续血压不稳。例如正在吃饭，突然感到气短，脸发热，就往床上躺。此时量血压，就升
到160左右。一会就好了。
我昨天联系了很多医生，都不肯接收cash payment的病人。只好带妈妈去了urgent
care. 结果那里的医生只开了治牙的抗生素(虽然牙现在已经不疼了），明确告诉我高
血压不是urgent care 的
business. 如果血压再高，就去急诊。付了150元诊费，连evaluate一下现在的降压药
是否合理都不肯。
来版上询问好心人，我妈妈这种情况是否严重，还有什么办法吗？她现在大部分时间血
压还是正常的，估计到急诊也不接收的。
谢谢
☆────────────────────... 阅读全帖 |
|
R****y
发帖数: 411 | 25 Well, to make definitive imaging diagnosis of hemangioma, you need to have a
two oe three phase scan, with images acquired during arterial, venous and
possibly delayed phases. your ct scan is most likely single phase, that's
they called it possible hemangioma. |
|
l*h
发帖数: 4124 | 26 you have done a lot of research yourself and your understanding is correct
for almost all the things you mentioned.
he should be thoroughly evaluated by a cardiologist first. some findings may
need further evaluation by other specialists.
for potential stenting of bypass surgery, he will need imaging studies to
determine how constricted his arteries are. in some patients, CT angiogram
or MR angiogram will suffice. they are basically non-invasive. others will
need standard angiogram.
for aspirin,... 阅读全帖 |
|
l*h
发帖数: 4124 | 27 1. whether his symptoms are angina?
2. if yes, then will need to image aorta and subclavian arteries. both left
and right coronary normally originate from aorta, but there are
abnormalities. |
|
b*h
发帖数: 637 | 28 > 1. whether his symptoms are angina?
我又问了我爸关于到底是不是心绞痛，他说是他自己觉得的，没有医生给他诊断过。他
的硝酸甘油也是问医生要，医生就给开的（晕。。。）他的犯病的时候就是胸口中中间
痛，反射到后背，再反射到右边的一颗牙痛。
》2. if yes, then will need to image aorta and subclavian arteries. both
left and right coronary normally originate from aorta, but there are
abnormalities.
我理解您是说CT应该去照（或是至少包括）大通脉和锁骨下动脉，因为左右两个冠状动
脉都是起源于主动脉。 但是我们现在的片子只照了左、右的冠状动脉，心肌和肺野（
对我们外行来说就是肺部）说没有异常。但是CT应该也照主动脉和锁骨下动脉。
想问一下，我们是不是直接应该要求做冠状动脉造影。之前有个大侠说过觉得做心脏CT
是鸡肋。 我父亲和医生要求做冠状动脉造影，医生说检查要一步一步来，先做个心脏
增强CT. 我爸爸周一... 阅读全帖 |
|
l*h
发帖数: 4124 | 29 there are quite some possible causes for angina without severe coronary
blockage:
1. coronary spasm (Prinzmetal's). occurs more often in young people, esp.
young women. in older people with this, most also have moderate coronary
blockage.
2. abnormal origin of coronary arteries.
3. microvascular angina.
4. Inflammation, infection, anemia, hypertension ... can also cause or
contribute to angina.
the information you provided is still sketchy, so cannot rule any one of
these out yet. |
|
l*h
发帖数: 4124 | 30 you have done a lot of research yourself and your understanding is correct
for almost all the things you mentioned.
he should be thoroughly evaluated by a cardiologist first. some findings may
need further evaluation by other specialists.
for potential stenting of bypass surgery, he will need imaging studies to
determine how constricted his arteries are. in some patients, CT angiogram
or MR angiogram will suffice. they are basically non-invasive. others will
need standard angiogram.
for aspirin,... 阅读全帖 |
|
l*h
发帖数: 4124 | 31 1. whether his symptoms are angina?
2. if yes, then will need to image aorta and subclavian arteries. both left
and right coronary normally originate from aorta, but there are
abnormalities. |
|
b*h
发帖数: 637 | 32 > 1. whether his symptoms are angina?
我又问了我爸关于到底是不是心绞痛，他说是他自己觉得的，没有医生给他诊断过。他
的硝酸甘油也是问医生要，医生就给开的（晕。。。）他的犯病的时候就是胸口中中间
痛，反射到后背，再反射到右边的一颗牙痛。
》2. if yes, then will need to image aorta and subclavian arteries. both
left and right coronary normally originate from aorta, but there are
abnormalities.
我理解您是说CT应该去照（或是至少包括）大通脉和锁骨下动脉，因为左右两个冠状动
脉都是起源于主动脉。 但是我们现在的片子只照了左、右的冠状动脉，心肌和肺野（
对我们外行来说就是肺部）说没有异常。但是CT应该也照主动脉和锁骨下动脉。
想问一下，我们是不是直接应该要求做冠状动脉造影。之前有个大侠说过觉得做心脏CT
是鸡肋。 我父亲和医生要求做冠状动脉造影，医生说检查要一步一步来，先做个心脏
增强CT. 我爸爸周一... 阅读全帖 |
|
l*h
发帖数: 4124 | 33 there are quite some possible causes for angina without severe coronary
blockage:
1. coronary spasm (Prinzmetal's). occurs more often in young people, esp.
young women. in older people with this, most also have moderate coronary
blockage.
2. abnormal origin of coronary arteries.
3. microvascular angina.
4. Inflammation, infection, anemia, hypertension ... can also cause or
contribute to angina.
the information you provided is still sketchy, so cannot rule any one of
these out yet. |
|
a**********2
发帖数: 3726 | 34 Large artery low flow TIA usually lasts minutes to hours.
Embolic TIA usually lasts hours.
is
the |
|
l*h
发帖数: 4124 | 35 you should ask more questions:
1. the reason to stent? vs. aggressive medical treatment.
2. which artery to stent?
3. what type of stent are they going to use?
stenting after stroke is controversial and multiple recent reports show the
vast majority of patients don't benefit from it. |
|
l*h
发帖数: 4124 | 36 curious, where was the chest X ray done? the report is in English with U.S.-
style format, but the English is kind of awkward and it lacks some analysis
you would expect to see for such comparison.
i am worried by the increased reticular grids, but as someone who is not a
lung specialist, and who knows not much about the clinical condition of the
patient, i cannot make a judgment whether interstitial pneumonitis was the
cause for this change.
was oxygenation checked? was arterial blood gas done ... 阅读全帖 |
|
h*w
发帖数: 20 | 37 补充一句：PCO2是通过IV 抽的血样，不是通过 arterial line 抽的血,测得值。
LMH：
您好！
我父亲在呼吸机上十六天了。我心急如焚！入院前八天按急性肺炎治疗，由于痰，血液
，大小便，支气管镜盥洗液中都没有培养出细菌来，医院更加确认是肿瘤进展，打算放
弃治疗，建议拔管。我和家人坚决不同意，父亲除了肺，其他器官都还健康，也没有远
处转移，究竟是癌症进展，还是化疗毒性太大，引起的一系列的针对肺的毒性反应，难
以确定。最近抽出大量胸腔积液后，我发现父亲的呼吸有所改善，建议医院无论如何让
我父亲脱一次机，不行再上，医院坚持脱机就不能再上机。就这样僵持着，我束手无策
。医院强调他们的目标就是确保父亲舒服。在最近一次SBT 中， 父亲自主呼吸了一个
半小时，他没有什么不良反应，医生偏说他的PCO2 (73) 值太高有危险，强行让我父亲
回到麻醉状态。本打算昨天再试着脱机，结果医生说我父亲又有新的肺炎（强调是插管
的结果），拒绝再试脱机。这样一天一天的耗着，心力交瘁，快崩溃了，请问这种情况
我该如何处理，多谢建议！ |
|
l*h
发帖数: 4124 | 38 why do you think the concern was Eisenmenger? it was NOT.
why do you think the pulmonary artery is significantly enlarged and extends
well into its branches? why do you think it should be ignored?
i do NOT think it is directly linked to the ASD.
why do you think Fawai's experts take that much pride in short-term visits
to small US hospitals unknown in cardiac surgery as short-term observers,
even list the visits on their online CV's as their major training, if it
were as good as you said? |
|
b*h
发帖数: 637 | 39 啊？！这个心脏痉挛是不是就是冠状动脉痉挛，英文叫Coronary artery spasm ？
脏痉挛的官方名称是心脏神经官能症吗？
这个“病”在中国叫做心脏神经官能症，英语叫做Da Costa's syndrome，是焦虑症的
一个临床表现，不是心脏的原发疾病。 |
|
T*R
发帖数: 36302 | 40 Coronary artery spasm is one of the major factors causing chest pain. |
|
|
|
x**********e
发帖数: 3 | 43 国内有个朋友的女儿前几天突然查出来患肺动脉高压 （pulmonary arterial
hypertension, PAH）, 目前还没有渡过危险期，据说后期也需要长期治疗主要以来进
口药物。国内的医生说没有什么特别有效的治疗方法。
不知道国外这边对于此病有没有有效点的治疗方式，以及哪些医院对此病的诊断治疗比
较有经验，可否能提供远程会诊。小女孩的家人现在都特别特别急，如果有治疗这个病
的成功案例能分享一下各种信息的话万分感谢！ |
|
l*h
发帖数: 4124 | 44 i am wondering what was done, or what was attempted right after the
discovery of her condition when she was half year old. at that time, there
might have been a chance for corrective surgery.
apparently when she was 3 yo, the surgery was palliative, not corrective,
likely because the right side pressure was already too high for corrective
surgery. all the efforts afterwards were to reduce right side pressure,
including Glenn.
the best chance is still to do something about the pulmonary artery st... 阅读全帖 |
|
q*********8
发帖数: 81 | 45 多谢LMH， 朋友说三岁前由于医疗水平和当时的经济问题没做任何手术，现在上海医院
推荐的也是pulmonary artery stenosis。 以你个人经验，这种手术在国内和美国做效
果差别大么？他女儿好像不能坐飞机，来美国也只有坐船。不过朋友什么都愿意试，只
要能把女儿治好。。。 |
|
A*S
发帖数: 354 | 46 From your post, it seems the symptoms are not caused by heart or cervical
vertebra . My thought is the the 颈内动脉（internal carotid artery）problem.
BTW, i am not specialist. |
|
d*w
发帖数: 384 | 47 1. PET has little use in the initial diagnosis of lung cancer. and her 18-
FDG was not normal either.
2. that sentence of mine was kind of sloppy. i didn't intended to say VATS
was not suitable for her, but rather should have said "surgery is necessary
as long as the patient can tolerate it." whether it should be an open chest
surgery or VATS depends on many factors in addition to the size of the tumor
, in this case the most important factors probably would be how close the
tumor is to the two ... 阅读全帖 |
|
d*w
发帖数: 384 | 48 1. establish a CT diagnosis.
2. if CT diagnosis is lung carcinoma, and her general health is ok, surgery
should be pursued. if the tumor is sufficiently far from the two segmental
arteries, and all centrally located nodes are completely negative, VATS
probably would be suitable. |
|
d*w
发帖数: 384 | 49 while many endocrine causes of secondary hypertension cause changes in a
patient's appearance, thyroid problems may not, as well as aorta and/or
renal artery problems. so pay extra attention in evaluating these.
was |
|
a*******e
发帖数: 831 | 50 请问一下在美国有没有比较好的over the counter治疗这两种病的药？ 谢谢了 |
|
