急性成人高原心脏病

本文首次报道了１４例急性成人高原心脏病，它既不同于以往所指的成人高原心脏病，也不同于小儿高原心脏病，暂称为急性成人高原心脏病。临床特点为：①健康成人进入高原后急性起病；②临床主要表现以右室损害为主的全心受累；③均伴有不同程度的其它类型急性高原病；④及时治疗或转入低地后心衰恢复顺利，心脏形态可完全恢复正常；⑤留居高原最终可发展成既往所指的成人高原心脏病。     

高原系统性红斑狼疮心脏损害的全病程研究

目的：探讨高原系统性红斑狼疮（ＳＬＥ）心脏损害的各期变化与演变过程。方法：３０例高原ＳＬＥ全病程资料,按病程分为５个年限梯度,分析Ｍ型、二维超声、多普勒测定的各心脏结构与功能参数,判定其统计学意义。结果：①高原ＳＬＥ心脏损害始于右室,然后依次累及右房、左室、左房;②其损害类型为先扩大,后肥厚;③心包积液发生于病情活动期与危重期;④危重期心脏结构与功能重叠受累。结论：高原ＳＬＥ心脏损害的基本演变过程为先右后左,先室后房,早期扩大,继而肥厚;无论病程长短,危重期多出现极严重的心脏影像学异常。     

高原系统性红斑狼疮心脏损伤的全病程研究

目的：探讨高原系统性红斑狼疮（ＳＬＥ）心脏损害的各期与演变过程。方法：３０例高原ＳＬＥ全病程资料，按病程分为５个年限梯度，分析Ｍ型、二维超声、多普勒测定的各心脏结构与功能参数，判定其统计学意义。结果：１高原ＳＬＥ心脏损害始于右室，然后依次累及右房、左室、左房；２其损害类型为先扩大，后肥厚；３心包积液发生于病情活动期与危重期；４危重期心脏结构与功能重叠受累。结论：高原ＳＬＥ心脏损害的基本演变过程为先     

高原心脏病患者NT-前端B型钠尿肽水平临床分析

目的检测高原性心脏病患者NT-前端B型钠尿肽（NT-ProBNP）的水平,探讨高原心脏病患者血浆NT-ProBNP变化及临床意义。方法对住院高原心脏病患者96例治疗前后的血浆NT-ProBNP进行检测,并与正常健康人89例（对照组）的NT-ProBNP的水平进行比较。结果治疗前,高原心脏病患者血浆NT-ProBNP浓度高于对照组,且随心衰严重程度加重而升高（P〈0.01）;治疗后,NT-ProBNP浓度降低（P〈0.01）。此外,高原心脏病右心扩大者血浆NT-ProBNP浓度较左心扩大及全心大者浓度低（P〈0.01）。结论测定血浆NT-ProBNP可作为判定高原心脏病病情严重程度的一项指标,对预后的评估起重要作用,但对单纯右室扩大者的诊断、治疗、预后判断要结合临床具体分析。     

高原心脏病心肌缺血临床研究

采用动态心电图、超声心动图与多导生理记录仪,对113例高原心脏病与117例高原正常人进行对照检查,两组比较心肌缺血、心律失常检出率差异极为显著(P<0.001);高原心脏病中缺血型ST段下移发作时频度、程度与同时伴发的心律失常、心功能恶化增级间极为相关(组间及组内两两比较P<0.01)。高原心脏病在右心功能异常的基础上,还存在左心收缩与舒张功能受损(与高原正常人比较P<0.001—0.05),显示高原心脏病是以右心为主的全心性疾病,有心肺与冠脉储备能力减弱等特点。     

高原病合并左前分支阻滞心电图133例分析

本文对133例高原病（其中高原心脏病18例，高原红细胞增多症36例.混合型慢性高原病56例，高原高血压18例，高原低血压5例）采用日本CF500型心电图机描记12个导联心电图，结果发现133例高原病合并左前分支阻滞病人，其中伴有右室肥厚劳损48例.左室肥厚劳损36例、双室肥厚12例，频发室上性早搏32例，频发室性早搏6例。作者认为高原缺氧使一些人心脏传导系统的血流供应受到影响，造成传导系统功能性障碍或器质性损害，尤其是左前分支细长只接受左冠状动脉前降支血流供应，当冠状循环功能障碍，则其分支的血流供应减少，因此左前分支极易出现功…     

超声评价左室E/e'比率增大与右心功能损伤的临床价值

目的探讨左室E/e'比率增大与右心功能损伤的相关性。方法选择左室舒张功能不全E/e'比率增大伴有继发性肺动脉高压(PAH)患者87例,获取右室功能参数,并分析E/e'比率增大与右室功能相关性。结果 E/e'比率增大继发PAH时,右室功能参数RVEF、TVSPV、GLS均减低。与正常对照组比较,轻度PAH患者的右室功能参数RVEF、TVSPV、GLS差异无统计学意义(P>0.05);中、重度PAH的右室功能参数RVEF、TVSPV、LGS差异有统计学意义(P<0.05);与中度PAH组相比较,重度PAH组的RVEF、TVSPV、LGS减低更明显(P<0.05);多元线性回归分析表明,两组E/e'与右室功能参数PASP、RVEF、TPSPV、GLS均有良好的相关性(P<0.01)。结论左心舒张功能减低时,随着PAH程度的增加,右室功能损伤的程度亦逐步增加,且损伤程度与E/e'比率增大相关,E/e'比率增大对评价此类患者右心损伤的发生发展有重要的临床价值。     

高原系统性红斑狼疮临危期心脏X线表现及临床意义

目的：探讨高原ＳＬＥ临危期心血管损害特征，为临床救治提供依据；材料与方法：总结高原ＳＬＥ病死组临危期、存活组活动期各３０例资料，常规测量ｘ线片心血管径线、分析心脏Ｂ超有关参数，进行统计学处理；结果：①活动期心影增大以右室或右室右房内径增大和心包积液为主，受累部位较局限；②临危期损害趋向多部位以至全心性，范围广泛而严重；③早期心脏损害多数始于右室，进而以右房、左室的顺序发展；④上腔静脉持续性增宽提示预后不良。结论：高原ＳＬＥ临危期心脏损害包括结构与功能多个方面，临床除控制病情活动外，应积极纠正心衰，前期氧疗能使临危期后移。     

低分子肝素联合前列地尔治疗高原心脏病顽固性心衰的临床疗效观察

高原心脏病（high altitude heart disease）以慢性低压低氧引起的肺动脉高压（hypoxic pulmonary hypertension,HPH）为基本特征并有右心室肥厚或右心功能不全。晚期出现右室肥厚扩大、全心衰,表现为顽固性心力衰竭,为海拔3 000m以上高原藏族老年人群常见病和死亡原因之一。高原心脏病顽固性心衰是其终末期常见的临床表现,治疗较为棘手。     

高原系统性红斑狼疮临床期心脏X线表现及临床意义

目的：探讨高原ＳＬＥ临危期心血管损害特征，为临床救治提供依据；材料与方法：总结高原ＳＬＥ病死组临危期、存活组活动期各３０例资料，常规测量Ｘ线片心血管径线、分析心脏Ｂ超有关参数，进行统计学处理；结果：１活动期心影增大以右室或右房内径增大和心包积液为主，受累部位较局限；２临危期损害趋向多部位以至全心性，范围广泛而严重；３早期心脏损害多数始于右室，进而以右房、左室的顺序发展；４上腔静脉持续性增宽提示预后     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.