本帖最后由 choi 于 3-26-2018 13:45 编辑
(b) I will talk about two other points in this essay.
(i) The patient had an episode "around Chjavascript:;ristmas," whose laboratory tests shows elevated troponin, despite normal heart rhythm (beats) and echocardiogram. Am Fam Physician. 72: 119-126 (2005)
https://www.aafp.org/afp/2005/0701/p119.html
This is hardly mysterious. See Achar SA et al, Diagnosis of Acute Coronary Syndrome. American Family Physician, 72: 119-126 (2005)
("Troponin T or I generally is the most sensitive determinant of acute coronary syndrome, although the MB isoenzyme of creatine kinase also is used. * * * A normal electrocardiogram does not rule out acute coronary syndrome")
In humans, troponin is only found in skeletal or cardiac muscles but not smooth muscle. Generally speaking, when a cell dies, the disintegration of the cell leads to release into blood stream of its innards. There are three isoforms of troponin: C, I and T. Troponin I and T will both elevate in acute and chronic heart conditions.
(ii) Hereditary hemorrhagic telangiectasia (HHT) is not much known beyond AVM. Wait until you read (f).
(c) To do a CT scan, the patient "would have one more needle stick (for the contrast dye) * * * Dr Tej Phatak [at Newark Beth Israel Medical Center] was both a pediatrician and the radiologist helping to manage her care. Through the control-room window, he saw the girl’s tear-streaked face disappear into the scanner, then watched the pictures click into place on his monitor. Suddenly he saw an irregularly shaped splash of brightness in the bottom of her right lung, in a place that should have been mostly dark. It looked like a tangle of vessels. He recognized it immediately. It was a pulmonary arteriovenous malformation, or PAVM, an abnormal connection between a pulmonary vein and an artery."
(i) Arteriovenous malformation is rare, but can be anywhere in the body: brain, gastrointestinal tract (GI tract, 肠胃道) etc. This disease is usually taught in neurology 神经内科, whose rupture within skull is catastrophic.
(ii)
(A) In CT scan without contrast medium, lungs (filled with air) look black, and bone is the whitest. Blood vessels are not visible, unless they are major vessels, such as aorta 主动脉 and inferior vena cava 下腔静脉.
(B) Injection of contrast medium into blood vessels (arterial or venous, depending on goals), which brings about angiography 血管摄影术, makes blood white in X-ray or CT scan. Of course blood circulates, and a radiologist will, at the right time, pay attention to the region he is interested in. I will deal with lungs. Contrast medium would make lung a little whitish than without contrast medium, due to contrast medium in myriad capillaries throughout the lungs. However, after medium passes through normal blood vessels, it is temporarily retained by AVM, tumors etc, because abnormal vessels in the latter are tortuous, fragile (causing leaks internally) and take time to pass through. So you see a grayish blur.
(d) 孝金波, 医生：脑血管畸形患者在情绪激动、受撞击时易发病. 人民网, Aug 1, 2013
https://society.people.com.cn/n/2013/0801/c229589-22412806.html
("7月17日，湖南瓜农邓正加在与临武县城管人员的冲突中不幸身亡。据郴州市公安局31日晚通报，法医根据尸体检验情况及中山大学法医鉴定中心病理组织学检验结论综合分析认为，瓜农邓正加系外力作用诱发脑部畸形血管破裂出血死亡")
(i) The report did not say whether the patient had premonitions of
(ii) Some people in China did not believe the autopsy, because the deceased had no representative present during the autopsy.
(iii) Generally speaking, before eventual rupture of AVM causing stroke or death, the patient will experience headquakes, resulting from leakages of blood from AMV.
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发表于 3-26-2018 12:35:53
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