Monocyte adhesion molecule expression in interstitial inflammation in patients with renal failure.

BACKGROUND: Patients with renal failure have an increased susceptibility to infections. We therefore studied the recruitment of monocytes and their expression of adhesion molecules CD11b and CD62L at the site of interstitial inflammation in patients with renal failure. Furthermore, we studied if the capacity of monocytes to up-regulate CD11b in interstitial inflammation was determined by the interstitial concentration of chemotactic factors. METHODS: Three intensities of interstitial inflammation (0, intermediate and intense) were established in skin blister chambers. Leukocyte count, CD11b/CD62L expression, monocyte chemotactic protein-1 (MCP-1) and blister activity in terms of CD11b mobilization were determined. RESULTS: The CD62L expression on monocytes was lower in the peripheral circulation in patients with renal failure compared with healthy subjects (P<0.005 and P<0.001). At the site of interstitial inflammation patients had a higher expression of CD62L (intermediate, P<0.05; intense, P<0.005). Furthermore, monocytes from patients had an impaired capacity to mobilize CD11b both in the peripheral circulation (P<0.005) and at the intermediate and intense sites of interstitial inflammation (P<0.005 and P<0.001, respectively) compared with cells collected from healthy subjects. We incubated monocytes in blister exudates, in order to explore whether this phenomenon is caused by cellular factors and/or to the interstitial concentration of chemotactic mediators. The expression of CD11b on monocytes from healthy blood donors incubated in blister exudates from either patients or healthy subjects in vitro was similar. The interstitial concentration of MCP-1 at the site of intermediate inflammation was significantly lower in patients with renal failure compared with the corresponding blister exudate collected from healthy subjects (P<0.05), but no differences were observed at the site of intense inflammation. Furthermore, neutralizing the action of MCP-1 in blister exudates with monoclonal antibodies did not have any impact on monocyte CD11b expression following incubation in blister exudates. CONCLUSION: These studies indicate that the impaired capacity of monocytes to mobilize CD11b at the site of inflammation in patients with renal failure is more dependent on constitutive cellular factors than the concentration of CD11b mobilizing factors in the interstitium.     

养血清脑颗粒对慢性脑供血不足患者血管内皮功能的改善及血栓前状态的影响

目的探讨养血清脑颗粒对慢性脑供血不足患者血管内皮功能障碍和血栓前状态的干预效果。方法90例慢性脑供血不足患者按就时间顺序分为A组（对照组）、B组（养血清脑颗粒组）、C组（联合用药组）各30例,分别观察3组患者用药前和用药3个月后一氧化氮（NO）、血管内皮素-1（ET-1）、纤维蛋白原（FIB）、组织型纤溶酶原激活物抑制物（PAI-1）和组织型纤溶酶原激活物（t-PA）的变化,及内皮依赖性血管舒张功能（EDD）、非内皮依赖性血管舒张功能（NEDD）的变化,并进行对比分析。结果B组、C组经过治疗后,NO水平升高,ET-1水平和FIB减低,t-PA活性增强,PAI-1活性降低,EDD显著改善,两治疗组间相比差异无统计学意义；两治疗组治疗后分别与对照组相比差异具有统计学意义。结论服用养血清脑颗粒能够有效改善慢性脑供血不足患者的血管内皮依赖性舒张功能及血栓前状态,可以作为脑血栓形成的一级预防治疗。     

椎动脉型颈椎病患者中缩血管活性肽类物质的变化及意义

目的　探索缩血管活性肽类物质在椎动脉型颈椎病发病时的变化情况及病理意义。方法　椎动脉型颈椎病治疗组 30例 ,正常组 30例 ,椎动脉型颈椎病患者均采用中医手法治疗。正常组和治疗组患者分别在治疗前和治疗后空腹取静脉血进行神经肽类物质NPY、ET、CGRP、ANP放射免疫检测。结果　治疗前椎动脉型颈椎病患者的血浆NPY、ET、ANP明显高于正常组 ,而CGRP的含量则低于正常组 (P <0 0 5) ;经过治疗后患者的血浆NPY、ET、ANP含量降低 ,CGRP的含量升高 ,与治疗前比较具有显著性差异 (P <0 0 5)。结论　缩血管活性肽类物质在椎动脉型颈椎病发病时可能起重要的神经 体液调节作用     

Mitral insufficiency with congenital double-orifice mitral valve in an elderly patient.

We describe the case of a 79-year-old woman with mitral insufficiency and a double-orifice mitral valve (DOMV), discovered by echocardiography. Transthoracic echocardiography showed two insufficiency jets. Transesophageal echocardiography revealed a DOMV. Each orifice was provided with a subvalvular apparatus. No associated congenital abnormalities were present. Our case demonstrates that even in elderly patients with a double regurgitant jet, DOMV should be suspected and assessed by transesophageal echocardiography.     

Rotational occlusion of the vertebral artery at the atlantoaxial joint: is it truly physiological?

We present a patient with vertebrobasilar insufficiency, with vertigo and horizontal nystagmus, induced by turning the head to the right. Angiography demonstrated transient occlusion of the left vertebral artery at the atlantoaxial joint during rotation of the head. The pathogenesis and angiographic findings are discussed.     

60例老年椎—基底动脉供血不足的脑干听觉诱发电位分析

对60例临床诊断为椎—基底动脉供血不足的老年人进行脑干听觉诱发电位(BAEP)检查,51例异常者(异常率为85％)均在发作期检查,9例颈性眩晕病人于缓解期检查(BAEP)正常。BAEP异常提示老年人可能由于长期椎—基底动脉供血不足造成脑干内有影响听觉通路的微小梗塞灶。证明BAEP检查叫老年性椎—基底动脉供血不足的诊断很有价值。     

Effect of cirrhosis and renal failure on the kinetics of clotiazepam

Summary The kinetics of a single 5-mg oral dose of the thienodiazepine clotiazepam was evaluated in a series of patients with biopsy-proven cirrhosis, and in patients with renal insufficiency requiring maintenance hemodialysis, compared to healthy matched controls. Clotiazepam volume of distribution (V_z) was significantly smaller in cirrhotic patients than in controls (1.83 vs 2.57 l/kg), and total clearance was likewise reduced (2.15 vs 3.15 ml/min/kg). Elimination half-life was similar between groups (10.0 vs. 10.2h). There were no significant differences between renal failure and control patients in clotiazepam V_z, oral clearance, or elimination half-life. Thus cirrhosis is associated with reduced clearance of clotiazepam, probably due to impairment of its microsomal oxidation. However clotiazepam disposition is not significantly altered in dialysis-dependent renal insufficiency patients.Supported in part by Grant OC 10/6–4 from Deutsche Forschungsgemeinschaft, and Grant MH-34223 from the United States Public Health Service.     

慢性肾功能不全患者行冠状动脉搭桥术围术期处理

目的：探讨慢性肾功能不全患行冠状动脉搭桥术的安全性。方法：回顾性分析1996年6月至2001年6月收治的15例慢性肾功能不全患行冠状动脉搭桥术的临床资料，并复习献。结果：9例患术后早期肾功能指标较术前差；6例患术后早期肾功能技术前无明显变化。围术期腹透4例，血透2例，其中1例行术中血透，肾功能指标均有所改善。全组无术中死亡，1例枚后第三天死于多器官功能衰竭。结论：术前肾功能不全的患，经过积极的术中及围术期处理，大多可以安全渡过肾功能衰竭关，接受冠状动脉搭桥术，达到改善症状延长生命的目的。     

Aortic valve injury 10 years after tetralogy of Fallot repair

Summary Although recognized by pediatric cardiac surgeons, aortic insufficiency as a technical complication after tetralogy of Fallot repair is poorly documented, especially if it occurs late. The case of a boy with aortic insufficiency 10 years after complete tetralogy repair is described. No documentation in the literature other than summary statements in textbooks of this occurence was found.     

老年主动脉瓣闭锁不全的彩色多普勒超声心动图研究

报告接受彩色多普勒超声心动图检查的老年患者162例，其中75例有不同程度的主要动脉瓣关闭不全（Ar)。老年（Ar)的病因构成与中，老年前期者明显不同，主动脉，瓣钙化及原因不明者的比例占多数（67％）。主动脉瓣钙化者Ar程度多较重。主动脉瓣钙化及原因不明Ar患者的其他三个瓣膜返流检出率及和程度均明显高于无Ar的老年患者。表明多瓣膜退行性病变是此类Ar患者的原因之一。