Unique variant of partial anomalous pulmonary venous connection with intact atrial septum

Summary Partial anomalous pulmonary venous connections (PAPVCs) are rare in association with an intact atrial septum. However, the diagnosis should be considered in patients with otherwise unexplained findings of left-to-right shunt and right heart enlargement. An unusual variant is presented, which we considered unsuitable for operative repair, based on findings at catheterization. Developmental, hemodynamic, and surgical considerations are discussed.     

8～12岁单纯性肥胖儿童心功能研究

利用多导生理仪，同步记录心电图、心音图、颈动脉搏动图和心阻抗微分图，测试８～１２岁肥胖儿童９４名，对照组儿童７６名，分析比较有关心功能数据。结果显示肥胖儿童收缩压、舒张压、平均动脉压、左室射血时间和心搏出量高于对照组儿童，心输出量与对照组比较差异无显著性，心功能指数低于对照组儿童。提示肥胖儿童由于回心血量增加，血压增高，而使心脏前、后负荷加重，心肌收缩力代偿性增强，单位体表面积心输出量下降，部分心功能指标已受到影响。     

不稳定性心绞痛患者肌钙蛋白I及C反应蛋白的临床意义

【目的】探讨不稳定性心绞痛 (UA)病变程度及其预后与血浆肌钙蛋白I (cTnI)及C反应蛋白(CRP)水平的关系。【方法】测定 5 8例经选择性冠状动脉造影证实为冠心病的患者血浆cTnI及CRP浓度 ,并与对照组 (健康者 5 0例 )相比较 ,分析cTnI及CRP的临床意义。【结果】①血浆cTnI及CRP浓度在对照组、稳定性心绞痛组 (SA)、UA组分别为 :(0 4 2± 0 0 6 ) μg/L ,(2 2 93± 10 8) μg/L ;(0 5 9± 0 13) μg/L ,(5 2 16± 32 8) μg/L ;(1 92± 0 5 8) μg/L ,(13811± 86 1) μg/L ;SA组及UA组明显高于对照组 (分别为P <0 0 5 ,P<0 0 1)。②观察 4w ,在UA组心脏事件发生率为 35 5 % ,明显高于SA组 (P <0 0 5 )。③cTnI与CRP具有一定相关性 (r =0 5 1,P <0 0 5 )。【结论】血浆cTnI及CRP水平在临床评价UA病情程度及预后方面具有一定的指导意义     

空肠间置预防返流性食管炎的临床研究

目的 了解近端胃切除或全胃切除后间置空肠的消化道重建术，预防术后返流性食管炎的情况。方法 1995—2000年共收治30例贲门癌患者，对Henley消化道重建术式作了技术改进，将代胃的空肠长度增加至40cm以上，术后行食管胃肠造形，胃镜检查，取组织活检及返流液的pH测定。结果 改良的Henley术式符合正常的生理通道，操作简便易行，并发症少，术后生活质量好。结论 空肠间置术做为贲门癌切除(全胃切除或近端胃切除)消化道重建术式，可有效预防返流性食管炎的发生。     

The mechanical and morphological properties of bone beneath internal fixation plates of differing rigidity

The internal fixation of diaphyseal fractures by bone plates is a well recognized treatment. The normal physiological stress of bone is reduced by plates that cause a negative balance of bone-remodeling processes. Many investigators have shown that the degree of stress protection is dependent on the rigidity of the plates. It was the aim of this study to quantify mechanical and morphological changes at different locations in a plated diaphyseal bone as a function of differing plate rigidity. Two types of plates with the same size but different materials were used. The stainless steel plates had a modulus of elasticity and bending stiffness 3.2 times higher than the carbon fiber reinforced carbon plates. Both types of plates were applied to the intact right and left femora of six foxhounds for 6 months. The stiffer stainless steel plates led to a significantly higher bone loss and correspondingly greater loss of mechanical properties. These effects were greatest directly beneath the plate and less with increasing distance from the plate.     

Rhabdomyoma of the heart with intrapericardial expansion

A rare case of a rhabdomyoma originating from the surface of the right atrium in a 20-year-old female is reported. The tumor showed electrical activity and caused both outflow obstruction and tamponade symptoms. It was successfully removed by a right-sided thoracotomy. The clinical course, diagnostic investigations, and the therapeutical approach of this rare lesion are discussed.     

Bone remodeling during the development of osteoporosis in paraplegia

Summary Osteoporosis developing during the first weeks after the onset of traumatic paraplegia was studied with cortical and cancellous samples of iliac crest and tibia of 14 patients, and compared to normals. We used a procedure of bone particle fractionation (according to degree of mineralization) that allowed us to establish a profile reflecting the metabolic remodeling of bone and to analyze the organic matrix of the newly synthesized tissue. In paraplegics, we observed a large increase in the proportion of little calcified bone in the cortical as well as in the cancellous bone. Based on amino acid analyses, we found a decreased number of hydroxyproline residues in the newly synthesized organic matrix from paraplegia bone resulting either from an alteration of the prolyl hydroxylation or from the presence of an excess of noncollagen polypeptides. These results, together with previously published data reporting increased urinary hydroxylproline and calcium kinetic parameters, suggest an enhanced rate of skeletal remodeling in acute paraplegia. When investigated 2 years after injury, the patterns of distribution approach that of normal subjects.     

解耦联蛋白在心肌中的表达与心力衰竭

位于心肌线粒体内膜上的解耦联蛋白 (UCPs) ,作为质子通道驱散氧化呼吸时形成的H 梯度 ,使产能转化为产热 ,从而增加呼吸 ,阻止ATP形成 ,并抑制活性氧族的产生 ,最终阻止了心肌细胞的程序性死亡。脂肪酸、寒冷、甲状腺激素、肾上腺素等能调控UCPs的浓度和活性。UCPs在心力衰竭中的作用仍然不清楚 ,有待进一步研究     

经面罩机械通气治疗急性肺水肿的疗效观察

目的 研究经面罩机械通气(FMMV)对急性肺水肿的治疗效果。方法 34例肺水肿患者,分为对照组12例,采用常规治疗;治疗组22例,在常规治疗的基础上或常规治疗效果不佳的情况下给予FMMV,观察临床表现、胸部X线片和动脉血气的变化。结果 FMMV后30min内,91％的患者能较好耐受,所有患者呼吸困难皆明显改善,呼吸频率由(37±7)次/min降至(26±5)次/min(P<0.05),心率由(122±21)次/min降至(94±27)次/min(P<0.05),4例(18％)低血压患者血压迅速回升。77％的患者24h内咳嗽、咳痰和肺部湿啰音基本缓解。临床症状的总体好转速度治疗组明显高于对照组。吸氧流量相同的情况下,治疗组1h后PaO_2由(62±10)mm Hg升至(78±18)mm Hg(P<0.05),2～6h后升至(96±22)mm Hg(P<0.05),PaO_2升高的速度和幅度皆较对照组显著;脱机时,治疗组在吸空气条件下PaO_2维持在(79±8)mm Hg(P<0.05),PaCO_2和pH也逐渐恢复正常。95％的患者在24～48h内脱离呼吸机。结论 与常规治疗相比,FMMV可迅速改善心功能,并更快改善肺水肿和低氧血症。     

比索洛尔对冠心病心力衰竭患者心室重塑和心功能的影响

目的 :探讨比索洛尔对冠心病心力衰竭患者心室重塑及心功能的影响。方法 :冠心病心力衰竭患者 12 0例 ,左室射血分数≤ 45 % ,心功能 (NYHA)Ⅱ -Ⅳ级 ,常规治疗基础上随机分为比索洛尔治疗组和对照组。治疗 6个月 ,观察比索洛尔对心室重塑、心功能的影响。应用心脏彩色超声仪测定基线值及 1个月、3个月、6个月左室结构及功能指标变化。结果 :比索洛尔平均用量为 (7 5 0± 2 5 0 )mg/d ,经过 6个月治疗 ,比索洛尔治疗组症状和心功能改善 ,与对照组比较左室射血分数上升 [(4 9 2± 2 8) %VS(3 9 6± 3 6) % ,P <0 0 5 ] ,左室收缩末容积下降[(15 7 7± 42 6)mlVS(180 9± 3 9 6)ml] ;与基线比较左室舒张末容积下降 (P <0 0 5 )。结论 :在强心、利尿、血管紧张素转化酶抑制剂基础上 ,应用比索洛尔能显著改善冠心病心力衰竭患者的心功能 ,改善心室重塑。长期应用可改善衰竭心脏心肌细胞的生物学效应 ,这种有益的作用在不同心功能级别间无显著性差异