Objective:To explore the optimal dose of atrovastatin treating acute coronary syndrome (ACS) .Methods:A total of 86 ACS patients were randomly and equally divided into atorvastatin large dose group (40 mg/d) and rou-tine dose group (20 mg/d ) . Blood lipid levels , blood lipid standard-reaching rate , serum levels of adiponectin (APN) and high sensitive C reactive protein (hsCRP) were compared between two groups before and after treat-ment .All patients were followed up for six months after discharge ,and incidence rates of cardiovascular events and adverse reactions were compared between two groups .Results:Compared with routine dose group ,the levels of TC and LDL-C significantly reduced on 3 months after treatment ,in large dose group (P<0.01 ,<0.05 respectively);the standard-reaching rates of TC and LDL-C [TC:(23.3% vs .44.2% ) ,LDL-C:(37.2% vs .60.5% ) ,P<0.05 all];level of APN [ (8.47 ± 1.73) mg/L vs .(12.96 ± 2.15) mg/L] significantly rose ,level of CRP [ (6.23 ± 1.26) mg/L vs .(4.07 ± 1.54) mg/L] significantly reduced ,P<0.01all;incidence rate of adverse cardiovascular e-vents (23.3% vs .7.0% , P= 0.035) significantly reduced ,but there was no significant difference in incidence rate of adverse reactions between two groups ,P=0.213.Conclusion:Atorvastatin therapy can effectively reduce in-cidence rate of cardiovascular events in ACS patients ,and the dose 40mg/d is optimal dose .

Objective To analyze CT manifestations of inguinal canal lipomas (ICLS).Methods CT datas of 104 pa tients with ICLS was retrospectively analyzed.And the imaging features were observed by MPR.Results The main CT manifestations of the ICLS were fat density in the inguinal canal and were unconnected with the abdominal fat.Among the 104 ICLSpatients,male (90/104,86.54％) was more than famale(14/104,13.46％;x2=55.538,P＜0.001).Thele sions were located at bilateral sides in 8 cases,left side in 66 cases and right side in 30 cases.The lesions in left side were more than those in right side (x2 13.500,P＜0.001).The mean maximum cross-sectional area of ICLS was (3.89 ± 2.12)cm2.There was no statistically significant difference between male and famale in maximum cross-sectional area (t=1.038,P=0.302).Conclusion In ICLS patients,male is more than famale.And more lesions are located at the left side.The CT manifestations of ICLS have certain characteristics,and MPR images are helpful in diagnosing ICLS.

Objective To explore the feasibility and value of MSCT for the evaluation of hypophysoma before and after endonasal transphenoidal microsurgery.Methods 82 patients with hypophysoma intended to be treated by endonasal transphenoidal microsur-gery,were examined by 64-slice head CT angiography (CTA).All the images were transmitted to workstation and reconstructed by MIP、VR and MPR.The hypophysoma were typed according to the relationship between hypophysoma and its surrounding vessels. The shortest and longest diameter between internal carotid arteries of two sides,tumor length and width,the diameter between ex-ternal naris and the rear wall of sphenoid top and the length from external naris to the rear wall of tumor top were measured in VR images.Sphenoid division was observed in coronal plane image.Major vascular injury,bleeding,and residual tumor situation were observed on postoperative CT review.The surgery effect was evaluated by three associate professorwith SPSS 13.0.Results 39 ca-ses were type-A,30 were type-B,13 were type-C,tumor length ranged from 1.7 cm to 3.9 cm,width ranged from 1.3 cm to 2.5 cm,the diameter between external naris and the rear wall of sphenoid top and the length between external naris and the rear wall of tumor top were 6.9 cm~7.6 cm and 9 cm~12.2 cm.There are 1 5 cases of sphenoid without division,34 cases with one divi-sion,26 cases with two division and at least three division in 7 cases.The surgery effect was better in those which tumor size was relatively smaller compared to the diameter of the internal carotid artery.The evaluation of endoscopic endonasal transsphenoidal surgery with three types of pituitary adenomas had a significant difference (P <0.05).Conclusion MSCT can preferably reflect the spatial location relationship between pituitary adenimas and its surrounding structure,and it is effective evaluation methods for pre-operative and postoperative evaluation of transnasal microsurgical resection.

Objective To explore the application value of multi-slice CT angiography (MSCTA)in posterior approach of upper cervical vertebrae.Methods Fifty-one patients with suspected or conformed upper cervical disease were collected and performed cer-vical CTA examination.Twenty three patients underwent internal fixation surgery of posterior upper cervical and reviewed with CTA examination.Volume Render (VR),Maximum Intensity Projection (MIP)and Multi-planar Reformation (MPR)were used to show the courser and anatomical variation of vertebra artery,the shape of vertebrae,the relationship between the vertebra artery and adjacent structure,advantage artery.The distribution of screw placement,including perforation of the anterior wall,the inner wall, the outer wall,the upper wall,the interior wall and the inner wall of occipital were observed by VR,MIP and MPR after surgery, especially the relationship between the screw and vertebra artery,the screw and spinal cord.Comparing the correlation between the screw placement and postoperative symptoms.SPSS1 9.0 statistical packages were used for statistical analysis.Results VR,MIP and MPR can show the courser and nearby space relationship of cervical artery.The number of advantage artery was 25,equilibra-tion was 26,dysplasia variation was 13,course variation was 4.The number of tiny pedicle was 1 6,including 9 cases of ipsilateral advantage artery.The postoperative data analysis of 23 patients showed that:C1 -20,C2 -36,C3 - 1 5,C4 -2,occipital 40.The number of accurate screw placement was 83.Different type of perforation was 30,including 3 screws closing to vertebra artery,1 screw closing to spinal cord.All 23 patients were asymptomatic after surgery.Conclusion MSCTA can reflect the morphology of cervical vertebral,the spatial relationship between cervical vertebral and surrounding structure,which can provide an accurate refer-ence for clinical screw placement and improve the accuracy .The postoperative CTA can show screw placement accurately,which has great reference for the evaluation of clinical success rate of surgery and post-surgery treatment.

OBJECTIVE: To investigate the causes and features of medical disputes in percutaneous coronary intervention (PCI) in the cardiology and to provide references for forensic expert testimony and medical disputes prevention. METHODS: Fifty one disputed fatal cases in PCI were analyzed in terms of the cause of death, informed consent and medical operations retrospectively. RESULTS: Thirty five cases were due to medical negligence, 28 due to defect technical operation, 2 due to mistake medical management and 5 due to both defect technical operation and mistake medical management. CONCLUSION The causes of PCI medical negligence are defect medical operation, violate medical disciplines and insufficiency of informed consent.
Adult ; Aged ; Angioplasty, Balloon, Coronary ; Cause of Death ; Coronary Artery Disease/therapy* ; Expert Testimony ; Female ; Humans ; Male ; Malpractice ; Medical Errors/statistics & numerical data* ; Middle Aged ; Myocardial Infarction/etiology* ; Postoperative Complications/etiology* ; Retrospective Studies

OBJECTIVE: To investigate the relation of blood arsenic concentration (BAC) with clinical effect and safety of arsenic-containing Qinghuang Powder (, QHP) in patients with myelodysplastic syndrome (MDS). METHODS: Totally 163 patients with MDS were orally treated with QHP for 2 courses of treatment, 3 months as 1 course. The BACs of patients were detected by atomic fluorescence spectrophotometry at 1, 3, and 6 months during the treatment, and the effective rate, hematological improvement and safety in patients after treatment with QHP were analyzed. RESULTS: After 2 courses of treatment, the total effective rate was 89.6% (146/163), with 31.3% (51/163) of hematological improvement and 58.3% (95/163) of stable disease. The hemoglobin increased from 73.48 ± 19.30 g/L to 80.39 ± 26.56 g/L (P<0.05), the absolute neutrophil count increased from 0.81 ± 0.48 × 10/L to 1.08 ± 0.62 × 10/L (P<0.05), and no significant changes were observed in platelet counts (P>0.05). Among 46 patients previously depended on blood transfusion, 28.3% (13/46) completely got rid of blood transfusion and 21.7% (10/46) reduced the volume of blood transfusion by more than 50% after treatment. The BACs were significantly increased in patients treated for 1 month with 32.17 ± 18.04 μ g/L (P<0.05), 3 months with 33.56 ± 15.28 μ g/L (P<0.05), and 6 months with 36.78 ± 11.92 μ g/L (P<0.05), respectively, as compared with those before treatment (4.08 ± 2.11 μ g/L). There were no significant differences of BACs among the patients treated for 1, 3 and 6 months (P>0.05). The adverse reactions of digestive tract during the treatment were mild abdominal pain and diarrhea in 14 cases (8.6%), and no patients discontinued the treatment. The BACs of patients with gastrointestinal adverse reactions were significantly lower than those without gastrointestinal adverse reactions (22.39 ± 10.38 vs. 37.89 ± 11.84, μ g/L, P<0.05). The BACs of patients with clinical effect were significantly higher than those failed to treatment (40.41 ± 11.69 vs. 23.84 ± 12.03, μ g/L, P<0.05). CONCLUSION QHP was effective and safe in the treatment of patients with MDS and the effect was associated with BACs of patients.