肥厚性心肌病心尖肥厚亚型的临床诊断(附28例临床报告)

目的对心尖肥厚型心肌病的辅助诊断进行探讨。方法以心电图、超声心动图、放射核素心肌断层显像、冠状动脉造影及左室造影等检查方法，诊断２８例心尖肥厚型心肌病。结果２８例心电图显示胸导联倒置的Ｔ波呈ＴＶ４＞ＴＶ５的关系；超声心动图左室心尖部（乳头肌水平以下）心肌肥厚达１２ｍｍ以上；１８例行放射核素心肌断层显像见左心室心尖部心肌肥厚；２０例左心室造影均提示心尖部心肌肥厚、冠脉造影正常，其中１１例左心室舒张末期呈“黑桃”样改变。结论标准１２导联心电图显示胸导联倒置的Ｔ波伴Ｒ波振幅增高，而不伴有高血压病史者，应高度注意心尖肥厚型心肌病的诊断。     

心尖肥厚型心肌病的临床诊断(附13例临床报告)

目的：探讨心尖肥厚型心肌病的心电及影像学检查的特点及临床诊断价值。方法：对13例心尖肥厚型心肌病的心电图、超声心动图、放射核素心肌断层显像、冠状动脉造影及左室造影、磁共振成像等检查方法进行分析总结。结果：心电图的典型改变是胸前导联巨大倒置的T波伴ST段下降和QRS波群高血压,以V4导联最为显。超声心动图示心尖部肥厚,心尖部心室腔狭小甚至闭塞。磁共振成像清晰显示心尖部心肌肥厚。心室造影左心室舒张末期呈“黑桃”样改变,但部分呈“非黑桃”样改变。结论：心电图胸前导联巨大倒置T波TV4＞TV5伴QRS波群高血压RV4＞RV5是诊断AHCM的重要线索。超声心动图是诊断AHCM的重要手段。磁共振成像对确诊该病最有价值。心血管造影及放射性核素心肌显像是AHCM的鉴别诊断手段但不是必备检查。     

心尖肥厚型心肌病临床诊断探讨(附18例临床报告)

以心电图、超声心动图、放射核素心肌断层显像（99mTC－MIBI）、冠状动脉造影及左心室造影等检查方法，诊断18例心尖肥厚型心肌病。18例心电图显示胸导联倒置的T波呈TV4＞TV5TV5＞DV6的关系。超声心动图左心室心尖部（乳头肌水平以下）心肌肥厚，达12mm以上。8例行放射核素心肌断层显像见左心室心尖部心肌肥厚。10例左心室造影均提示心尖部心肌肥厚，其中6例左心室舒张末期呈"黑桃"样改变，冠状动脉造影正常。此文就18例心尖肥厚型心肌病的临床诊断进行探讨。     

心尖肥厚型心肌病4例报告

目的 :认识心尖肥厚型心肌病的临床表现及其诊断方法。方法 :对 4例年龄 60～ 69岁患者常规进行临床体检、12导联心电图、超声心动图、心肌核素扫描及心导管检查。结果 :4例患者经超声心动图检查发现左室心尖部心肌不对称性肥厚 ,心尖部运动减低 ,收缩期心尖腔狭窄呈线样闭塞状。 2例行左室造影显示 :收缩期心尖腔呈线样闭塞 ,其远端可见造影剂滞留呈“黑桃心”状。舒张期心尖腔缩小呈梭形。结论 :心尖肥厚型心肌病是肥厚型心肌病的一种特殊类型 ,其临床表现易与冠心病混淆 ,超声心动图及心室造影有助于该病诊断。     

心尖肥厚型心肌病18例临床分析

目的:对心尖肥厚型心肌病辅助检查进行分析,探讨其临床诊断价值。方法:以心电图、超声心动图、磁共振、冠状动脉造影及左室造影等检查方法检测18例心尖肥厚型心肌病。结果:18例心电图显示胸前导联T波倒置呈TV4>TV5>TV3,R波振幅增高以RV4>RV3> RV5;超声心动图左室心尖室壁舒张期厚度(17.22±14.20mm)与心室间隔基底段厚度(1.07±0.23mm)之比为1.60±0.16;4例冠状动脉造影检查后排除冠心病;6例因超声心动图不典型而行磁共振心脏成像检查后确诊。结论:标准12导联心电图显示胸前导联T波倒置伴R波增高应高度怀疑心尖肥厚型心肌病,可进一步行超声心动图或磁共振检查确诊。     

老年心尖肥厚型心肌病冠脉造影特征

目的了解老年心尖肥厚型心肌病(APH)患者冠脉造影及心室造影特征。方法对我科1996～2003年7例老年APH患者冠脉造影资料进行分析。结果所有患者左冠脉普遍增粗,肌桥形成,心室造影见左室“黑桃样”改变,5例合并冠脉狭窄。结论老年APH患者以冠脉普遍增粗、肌桥形成及左室“黑桃样”改变为特征性冠脉造影改变,且合并冠心病概率高。     

心尖肥厚型心肌病的临床诊断探讨

目的 了解心尖肥厚型心肌病的临床表现和辅助检查特点。方法 总结２９例心尖肥厚型心肌病的临床表现和心电图,超声心动图,核素心肌断层显像,运动平板心电图及冠状动脉和左室造影的特征,确定心尖肥厚型心肌病的诊断方法。结果 心电图显示以胸导为主的导联Ｒ波振幅呈Ｖ４≥Ｖ５〉Ｖ３关系增高,同时伴有Ｔ波对称性深倒置,超声心动图和核素心肌断层显像显示心尖部肌肉肥厚,２０例活动平板心电图有心肌缺血,左心室造影心尖部肌     

心尖肥厚型心肌病13例诊断及误诊分析

目的讨论通过心电图、超声心动图及左室造影等检查诊断心尖肥厚型心肌病(AHCM)的可行性以及分析误诊原因。方法对13例AHCM病例的心电图、超声心动图、及左室造影结果进行分析。结果AHCM合并有心电图异常者13例(100%)其中有12例心电图有特征性改变;心超提示心尖区增厚者11例;左室造影提示舒张期黑桃A样改变的5例;有7例初诊误诊为冠心病。结论AHCM较易被误诊为冠心病,心电图、超声心动图、左室造影、MRI检查对于AHCM的早期诊断与鉴别诊断有重要意义。     

12例心尖肥厚型心肌病的心电图分析

随着超声心动图的普及和发展,心尖肥厚型心肌病的检出日见增多。心尖肥厚型心肌病的心电图有一定特征性。本文就12例心尖肥厚型心肌病的心电图改变进行分析讨论,为临床诊断提供依据。 1 资料与方法 12例心尖肥厚型心肌病均经超声心动图证实,其诊断标准为:心尖部心肌厚度大于11mm,心尖部心肌与室间隔、室壁厚度之比大于1.3。1例胸痛较突出者,曾在上级医院作冠状动脉造影无异常发现,心室造影     

心尖部肥厚型心肌病的影像学诊断特点

目的 探讨心尖部肥厚型心肌病影像学检查特点,总结更为合理的诊断和治疗方法.方法 回顾性分析我院2004年1月至2010年1月期间60例诊断为心尖部肥厚型心肌病患者的临床表现,心电图、超声心动图、冠状动脉造影、左室造影、256层螺旋CT及心脏磁共振检查的特点,以及治疗后随访1年的心血管事件.结果 60例患者中56例表现为V1～V6导联 ST段压低,T波倒置,尤以V4 T波深倒;1例为完全性右束支传导阻滞;2例表现为AVR抬高,V3～V6导联ST段压低,T波倒置;1例Ⅲ、V1 T波倒置,V2～V6 T波双向.超声心动图异常改变48例（80%）,其中38例表现为不同程度的心尖部肥厚,厚度均≥15 mm,最厚可达22～24 mm.冠脉造影41例,仅有1例为前降支中段狭窄约70%,2例为前降支近中段肌桥形成,其余38例冠脉血管均正常.左室造影32例表现为左室腔舒张末期呈＂黑桃＂形改变,9例表现为＂猫舌＂状.10例患者行256层心脏及冠脉CTA检查,2例发现前降支近中段肌桥,8例冠脉正常;10例患者表现为心尖部增厚,厚度为15～21 mm.9例患者行心脏磁共振（CMR）检查,7例发现心尖部肥厚,厚度14～28 mm.结论 心尖部肥厚型心肌病容易误诊为冠心病.结合心电图和超声心动图可进一步明确,左心室造影、多层螺旋CT及心脏MRI为该病的诊断提供了确诊的依据.     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.