20:50,18,Dec,2011 | (190/0/0) | Original

multiple pulmonary embolism


For the disappearance of villi capillary matrix to hair matrix fluid, the formation of bubbles of varying sizes, the shape of grapes, so called mole (hydatidiform mole). Part of a complete distinction pregnant, most of complete hydatidiform mole. Clinical diagnosis of complete hydatidiform mole hydatidiform mole in terms of both means; part of the mole associated with placental tissue and / or the fetus who is labeled as part of the mole. Tissues in spontaneous abortion patients found that 40% of the blisters have some degeneration, but not diagnosed as hydatidiform mole.
Amenorrhea, clinical manifestations, mostly in the second three months of amenorrhea or individual more later, the vaginal bleeding. Blood may be more or less, was intermittent, in most cases greater than the postmenopausal uterus is possible in January. Uterine size of up to four or five months of pregnancy, not only pregnant women feel fetal movement, touch less than moles, have not heard of fetal heart rate. Careful examination of vaginal bleeding, such as found in hydatidiform moles, can be confirmed. B-abdominal scan, the uterus may have a size ranging from dark areas, the Department of intrauterine hemorrhage due. Also found that child, that is, except for snow-rays, may also be a fetus and / or placenta images. Diagnosis of B-device without any trauma, diagnosis rate, real effective measures for the diagnosis of hydatidiform mole.
Determination of hCG: hCG quantitative test for the accurate diagnosis and follow-up an important test of hydatidiform mole. the beginning of hCG in normal pregnancy less, while 8 to 10 weeks gestation and reached its peak, then decreased gradually. Gestational age (100 days), hCG decreased significantly. In the double (multiple) when pregnancy, hCG volume is higher than that of single births. The amount of hCG in the mole higher than normal, and continued as a high level. Normal non-pregnant women in the amount of serum hCG <75mIU/ml, β-hCG <20mIU/ml. Normal pregnant women, the median serum peak of 10 million mIU / ml below the maximum value of 210 000 mIU / ml, the molar serum hCG value is much higher than 200,000 mIU / ml. Therefore, to the combined clinical and B-, high-value individual hCG, to determine the diagnosis of hydatidiform mole. Quantitative such as making periodic checks followed up for hCG, the hCG values after 14 weeks of pregnancy is still high values, the diagnosis can be more clear.
Grape exclude more than 8 weeks, after careful curettage confirmed no residual intrauterine mole, there is no luteinized cysts, serum hCG remains at 1000mIU/ml or more, or has increased after the hyperchromic confirmed malignant change. The following values 1000mIU/ml hCG luteinized cysts and have a presence, still need to carefully check the transfer disease exists, or is likely due to the luteinized cyst, should closely follow-up. Such as flavin cyst subsided, with hCG decreased, according to follow-up of benign mole.
In rece
nt years, various forms of hCG and its significance in the understanding of the molecular structure has developed greatly. Cole so that in normal pregnancy and trophoblastic cells in the blood of patients with at least 7 kinds of immune activity with the hCG molecules. It as ① natural hCG; ② notch hCG (β44-45, β47-48 or β48-49-bit peptide coupling loss); ③ acidic hCG; ④ β natural free β subunit; ⑤ notch free β subunit; ⑥ β core fragment and ⑦ serum β core fragment - protein complex. The mouth has been found in patients with trophoblastic disease, hCG and related molecules are abnormal quantity and quality. Kardana and other reports, by the free β subunit specificity of the immunoassay results showed that in normal pregnancy, hydatidiform mole and choriocarcinoma, the free β subunit of the total β subunit (hCG free β0 ratio were 1.3%, 0.2% and 25%. different hCG-depth study of the clinical applications are in.
Immunization (sheep red blood cell agglutination inhibition test, etc.) determination in normal pregnancy test morning urine hCG, the highest concentrations generally in the 160,000 IU / L below, occasionally up to 640 000 IU / L. Diagnosis of hydatidiform mole generally 50 million to 60 million IU / L between, and the continuing decline.
Few X-ray Diagnosis of hydatidiform mole. 】 【Treatment
First, the Qing bleeding at any time by mole may be, it is diagnosed, should be promptly removed uterine contents, the general aspiration Palace surgery. In the contents sucked out of the process, the uterus gradually narrowing and hardening. Aspirate in the blood, although with more, but most of the original plot for the uterine blood, so the patients pulse, blood pressure generally showed little change. Many people claim such as the uterus more than navel, should be implemented mole abdominal cesarean section, that this can be completely removed under direct vision, and can better stop the bleeding. However, in practice, even if the uterus swell to seven months of pregnancy is greater, the application technique can also successfully remove smoke Gong. If you need a hysterectomy can be carried out immediately after the smoke house. Cesarean section renvoi mole to mole planted Hu, transfer possible. No smoking house equipment to the cervix in the expansion, the clamp mole. The pursuit of the first Qing need not be too full, which damage the soft uterine wall. Can be about 1 week, then a second curettage.
Patients are often treated by curettage, there are still bleeding and the doctor who handled according to the circumstances. Suspected mole incomplete miscarriage (incomplete scraping or suction blisters tilting the new generation), curettage may be prudent to conduct a comprehensive, if still bleeding, uterine wall should be considered invasive disease, malignant mole and choriocarcinoma see.
Mole spontaneous abortion should be curettage. Qing whether intravenous uterotonic, have a different view. Oppose the use of agents to promote uterine contractions are considered a strong contraction may force a large number of molar villi into the blood circulation, causing embolism or a large number of grapes down into the blood circulation, causing embolism or metastasis. Therefore, surgical procedures, such as uterine contractions well, that is not routinely contraction agents, only bad blood when the uterus to contract more and apply.
Second, hysterectomy, more than 40 years of age or over by the maternal uterine growth rate, should be advised to remove the uterus, the young may consider retaining the ovaries. More than 5 months pregnant uterus in the removal of the first, shall be removed by the vaginal cavity for most hydatidiform moles in order to facilitate surgical treatment.
Third, severe anemia, blood transfusion should be given a small amount of blood transfusion several times slowly, and close observation of patients with and without active bleeding, to a certain extent when the situation improved after the implementation of curettage. In case of active bleeding should be in the Qing at the same time, be a blood transfusion.
Fourth, to correct the long-term blood electrolyte imbalance, loss of appetite often have dehydration, electrolyte imbalance, check corrected.
Fifth, the long-term infection control uterine bleeding, or after repeated dirty operations, are prone to cause infection, expressed as local (uterine or accessories) infection or sepsis. Should be adequate anti-inflammatory drugs; and actively correct the anemia and electrolyte imbalance.
VI chemotherapy on whether to preventive chemotherapy benign mole, There is no consensus. According to the literature, do preventive chemotherapy after molar malignancy rate of the control group, no significant difference, or could, with some decrease, but not enough cases were statistically proven useful. Many scholars tried to identify a number of clinical and pathological risk factors for malignant transformation in order to predict gestational trophoblastic disease. It as: ① age of Feeling 40; ② postmenopausal uterus was significantly greater than in January; ③ urinary hCG immunoassay Responding to 107IU / L; ④ history of patients have hemoptysis; ⑤ Histologically, hyperplasia is not included in the malignant transformation of the parameters easily . Therefore, DNA and RNA of the Qing organizations to predict malignant FCM determination of a good objective indicators. This guidance mole targeted prophylaxis.
【Complication
First, the bleeding mole without timely diagnosis, treatment, recurrent bleeding can occur, uterine hemorrhage, resulting in loss of blood, can also occur when the natural discharge of major bleeding. Based on the already anemic, hemorrhagic shock can occur, even death. Therefore, as the acute treatment of hydatidiform mole should be a short delay it may cause more blood loss, harm patients. Second, the molar absorption incomplete abortion or spontaneous abortion after abortion palace, there may be remnants of hydatidiform moles. Not long before admission mole spontaneous abortion, can withstand the curettage surgery, curettage immediately. From the time the elderly, who have signs of infection, the application of antibiotics for a few days each control curettage.
Third, the mole embolism hydatidiform moles can be transferred or walk with the blood supply to parts of the body, most commonly the lung and vagina, and hemorrhage in the local form. A small emboli or without close scrutiny, it may subside on their own. Pei-liang, in the report, 1 case of oxytocin induction of labor with extensive lung metastases arising from mole, the occurrence of small pulmonary arteries recover from illness twin syndrome, died of pulmonary edema, congestive heart failure. Embolization can be different from malignant mole transfer, can be auto-immune suppression disappeared. Lin Qiaozhi, the Soviet Union should be wide Jieyou reported. After the implementation of chemotherapy that is still present as well.
Fourth, a malignant invasive mole or choriocarcinoma. Malignant transformation rate of about 10% to 20%. Details later.
V. luteinized cyst torsion occurred after discharge in the mole. When torsion occurs, immediately turn the uterine attachment surgery.
】 【Auxiliary examination
B-abdominal scan, the uterus may have a size ranging from dark areas, the Department of intrauterine hemorrhage due. Also found that child, that is, except for snow-rays, may also be a fetus and / or placenta images. Diagnosis of B-device without any trauma, diagnosis rate, real effective measures for the diagnosis of hydatidiform mole. Determination of hCG: hCG quantitative test for the accurate diagnosis and follow-up an important test of hydatidiform mole. the beginning of hCG in normal pregnancy less, while 8 to 10 weeks gestation and reached its peak, then decreased gradually. Gestational age (100 days), hCG decreased significantly. In the double (multiple) when pregnancy, hCG volume is higher than that of single births. The amount of hCG in the mole higher than normal, and continued as a high level. Normal non-pregnant women in the amount of serum hCG <75mIU/ml, β-hCG <20mIU/ml. Normal pregnant women, the median serum peak of 10 million mIU / ml below the maximum value of 210 000 mIU / ml, the molar serum hCG value is much higher than 200,000 mIU / ml. Therefore, to the combined clinical and B-, high-value individual hCG, to determine the diagnosis of hydatidiform mole. Quantitative such as making periodic checks followed up for hCG, the hCG values after 14 weeks of pregnancy is still high values, the diagnosis can be more clear.
Grape exclude more than 8 weeks, after careful curettage confirmed no residual intrauterine mole, there is no luteinized cysts, serum hCG remains at 1000mIU/ml or more, or has increased after the hyperchromic confirmed malignant change. The following values 1000mIU/ml hCG luteinized cysts and have a presence, still need to carefully check the transfer disease exists, or is likely due to the luteinized cyst, should closely follow-up. Such as flavin cyst subsided, with hCG decreased, according to follow-up of benign mole.
multiple pulmonary embolism

(Reporter correspondent Cai Min Hsieh Tung-sing to the guitar just interns Gu Zhiqin) two days, a painful message to spread in the basketball fans - national champion Moco's wife, August 25, Wang Fan in training women's basketball team incidence of fainting, the rescue of more than 20 days after February 15 passed away. Beijing 309 Hospital, diagnosed the cause of a "pulmonary embolism."
What is pulmonary embolism? Yesterday, the reporter connection Cardiothoracic Surgery, Tongji Hospital, Professor Li Jun, the Provincial People's Hospital Respiratory Professor Chen Guozhong and Wuhan Ci Ming, MD, medical director of Center for Song Jiling authoritative experts, for everyone to do one on the science literacy of pulmonary embolism.
"Pulmonary embolism" refers to pulmonary arterial obstruction by blood clots or other substances. Data show that the domestic rate of misdiagnosis of the disease up to 80%. Not been effectively treated patients with pulmonary embolism, the mortality rate of 20% -30%. The diagnosis of clear and timely treatment, the mortality rate will decline to 2% -8%.
Experts point out that the typical manifestations of pulmonary embolism: dyspnea, chest pain, hemoptysis, and syncope. However, some patients with no response - is easy to overlook such patients died.
Professor Chen Guozhong said that the main use of pulmonary angiography in the diagnosis of pulmonary embolism, chest X-ray and other tests are valuable, but ultimately depends on the doctor's level and experience. Song Jiling chief physician, said that the long-term bed trauma, postpartum, after surgery and oral contraceptives, hormone replacement therapy, and even obesity can increase the incidence of pulmonary embolism may be. At present, there were no special examination for pulmonary embolism, the public need to control weight and blood lipids through comprehensive measures to prevent "pulmonary embolism" and other cardiovascular diseases.
Related News: liver and kidney is not good, walk away point most computer users eat anything fruit younger age radiation cervical spine of young computer users Bacheng problems computer users today recommended the most cattle nutrition buoy women occupying an area of Holy Ghost installed per night Precocious baby milk powder to [toxic milk] is precocious girl who drink holy element [shady] Guo Degang behind the "Water Army" appeared [alternative] PK North drying certificate qualifications sister female [cruel] eat cats underground king chain survey , aged 34 is an IT company's senior program developer, he usually sat at the computer every day for 12 hours, sometimes up to 18 hours, one day early sudden death in the past, after an autopsy found he died from pulmonary embolism.
Because pulmonary embolism occurred in recent years, many of them and the use of computer-related, so the disease was also known as "E embolism", and now it has become a major health computer users killer.
It is understood that each of these pulmonary embolism caused by a large number of sudden death, it is estimated that in France more than 100,000 cases each year, patients in England and Wales there are 65,000 cases, while in Italy the new cases occurring each year at least 60,000 cases.
Sedentary prone to cause venous blood produced in the coagulation, thrombosis, the formation of migration to the lungs pulmonary embolism
Beijing Coal General Hospital, Department of Respiratory Medicine physician Nan Zhang told reporters that sedentary time is an important cause of pulmonary embolism, in addition to sedentary for a long time at the computer, and take a long time can cause pulmonary embolism caused by aircraft sudden death.
Speaking of reasons, Nan Zhang told reporters that prolonged use of computer or on the plane, often in a state of high tension or focus, not aware of any lower extremity discomfort, there will not be consciously active limbs, the lower limb venous pressure for a long time. Far away from the heart of lower limbs, easy to make poor leg blood is flowing to the heart, blood, produced almost at rest and solidified, thus easily lead to thrombosis, deep vein thrombosis when the shed, walk to the lungs, it may cause fatal pulmonary embolism.
White-collar workers and other mental, long-term business or bedridden, pregnant women and the elderly prone to pulmonary embolism
Early symptoms are spontaneous calf pain, swelling, local heat, pain, walking, or even result could not walk. The main symptoms include difficulty breathing, chest tightness, chest pain, coughing, bloody sputum, syncope, palpitations, etc., and some patients will appear on one side or both sides of the limb pain, swelling, if not promptly found, the patient is likely to sudden death.
Zhang Nan said, with a variety of pulmonary embolism is a potentially fatal clinical diseases, 90% of them took was based on clinical symptoms, such as difficulty breathing, chest pain or syncope, or hemoptysis occurs, the face appeared cyanotic They can appear alone, it can be shown together, seriously, that there will be shock, fainting or even sudden death.
In contrast, white-collar workers and other mental, long-term business or bedridden, pregnant women and the elderly because of less active for a long time without moving more capacity appears lower extremity venous thrombosis, blood clots to the lungs after falling off more easily lead to pulmonary embolism.
Zhang Nan suggested that regular sedentary after the event to look up, tiptoe to facilitate promotion of lower limb blood circulation, to drink more water flow and circulati
on for the body to do so to prevent thrombosis.
● Health Tips
Computer users have coup prevention of pulmonary embolism
Sedentary computer workers to prevent pulmonary embolism and computer enthusiasts can take the following preventive measures: clothing and footwear should be loose; working at a computer or Internet games 1 to 2 hours, you should stand up and some exercise, more lower leg and foot movement, running, jumping, or leg swing swing foot, or leg stretching, or doing squat etc, and to accelerate the lower limb blood circulation; drink plenty of water, do not smoke and avoid drinking alcohol or caffeine drinks; daily life, we should pay attention to not eat high-fat, high sugar, high salt diet, adhere to the light and nutritious diet; eat more vitamin C and vitamin E-rich foods, such as black fungus, tomato, and many more Eat fiber-rich oatmeal and fresh vegetables. In addition, folic acid and vitamin B12, on the blood vessels also have a protective effect.
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