血清CK-MB和cTnT水平评估先天性心脏病患儿介入治疗后心肌损伤的价值

目的探讨血清肌酸激酶同工酶MB（CK‐MB）和心肌钙蛋白 T （cTnT ）水平评估先天性心脏病（CHD）介入治疗后心肌损伤的价值。方法接受心导管介入封堵术CHD患儿152例分为继发孔型房间隔缺损（ASD组,49例）、膜部室间隔缺损（VSD组,61例）和动脉导管未闭（PDA组, 42例）三组,免疫抑制法和化学发光法检测术前、术后即刻及术后48 h血清CK‐MB和cTnT 水平。结果三组患儿术前血清CK‐MB和cTnT 均在正常水平。ASD、VSD组术后即刻血清CK‐MB水平均升高（P＜0．05或P＜0．01）;VSD组术后48 h血清CK‐MB水平低于术后即刻（P＜0．05）。三组术后即刻血清 cT nT 水平均升高（ P＜0．05或P＜0．01）。三组术后48 h血清 cT nT 水平均下降（P＜0．05）,但VSD、PDA组仍高于术前（P＜0．05）。结论检测血清CK‐MB和cTnT 两项指标均可用于评估CHD患儿介入治疗后心肌损伤,血清cTnT水平更敏感。     

Secondary acute myeloblastic leukemia with t(16;21)(q24;q22) involving the AML1 gene

A t(16;21)(q24;q22) translocation was detected by fluorescence in situ hybridization in a patient with acute myeloblastic leukemia previously treated for malignant lymphoma. While the breakpoint on chromosome 21 was within the AML1 gene as determined by FISH, the gene partner on chromosome 16 could not be identified. Band 16q24 appears to be rearranged in several types of myeloid proliferation and a review of the literature shows that these rearrangements most often occur in secondary leukemia and myelodysplastic syndrome or are part of complex chromosomal rearrangements.     

Elevation of cardiac troponins in exacerbation of chronic obstructive pulmonary disease

Objectives: To investigate the prevalence of serum troponin elevation in patients admitted to hospital with an exacerbation of chronic obstructive pulmonary disease (COPD). Methods: We examined the records of all patients admitted to hospital for treatment of COPD for serum troponin measurement, clinical features of myocardial ischaemia, oxygenation (pulse oximetry, arterial blood gas analysis), spirometry, and duration of admission. Results: Troponin elevation was observed in 58 of 235 (25%) presentations in which troponin was measured. Despite the troponin result, only seven of these 58 patients had been diagnosed with an acute coronary syndrome. New ECG evidence of ischaemia was uncommon. Patients with raised troponins tended to be older (75.7 vs 70.0 years, P = 0.001), had lower pulse oximetry (85.6% vs 89.6%, P = 0.003), were more acidotic (pH 7.34 vs 7.40, P= 0.002) and more hypercapnoeic (pCO₂ 58.0 vs 49.1, P = 0.04). There were no significant differences in serum creatine kinase. Patients with raised troponins had significantly longer admissions (5 vs 3 days, P = 0.001). Conclusions: Serum troponins are commonly raised in acute exacerbations of COPD and appear to reflect the severity of the exacerbation. In the majority of patients there is insufficient evidence to support the diagnosis of an acute coronary syndrome.     

脑活素改善血管性痴呆患者智能状况的临床研究

目的:探索脑活素对血管性痴呆患者智能状况的改善效果。方法:将29例符合血管性痴呆标准的患者分为对照组和治疗组。对照组用血塞通0.4g,治疗组在对照组的基础上加用脑活素20mL,10d为1个疗程,3年共6个疗程,其后分别采用中文版简易智能状态检查(MMSE)量表进行积分,用中国人修订韦氏成人量表(WAIS-RC)进行智力测验比较。结果:根据WAIS-RC测验结果,两组3年后知识(11.32±1.76比9.23±1.78)、领悟(13.19±1.85比11.24±2.12)、算术(10.18±1.32比8.63±1.25)、相似(9.46±0.68比7.56±0.98)、数字广度(10.12±0.69比8.68±0.97)、词汇(31.25±0.78比27.32±1.02)、数字符号(31.35±1.20比25.35±0.78)、填图(9.78±0.98比7.45±0.65)、图片排列(19.16±0.74比15.23±1.52)等项目比较,治疗组积分明显高于对照组(t=1.96～5.21,P<0.05或0.01)。治疗组治疗前后上述项目自身对照积分亦有显著提高(t=1.96～5.21,P<0.05或0.01)。结论:脑活素能有效抑制神经细胞的凋亡,减少脑功能的受累,治疗血管性痴呆,对老年群体的康复有一定的治疗作用。     

Diagnostik und Therapie der medialen Sprunggelenkinstabilität

Zusammenfassung Die mediale Sprunggelenkinstabilität liegt typischerweise nach einem Pronationstrauma des Rückfußes vor. Dominante Symptome sind ein Unsicherheitsgefühl sowie ein mediales giving way beim Berg- und Treppabgehen, während in der klinischen Untersuchung ein anteromedialer OSG-Schmerz und eine im Seitenvergleich erhöhte Pronationsstellung typisch sind. Für die Diagnosestellung dienen anamnestischen Angaben, klinische Untersuchung und konventionelles Röntgen unter Belastung. Während die MRT-Untersuchung eher selten benutzt wird, hat sich die Arthroskopie als sehr hilfreich für die Diagnosesicherung erwiesen. In Anlehnung an die derzeitigen Klassifikationen war die am häufigsten vorliegende mediale Sprunggelenkinstabilität das Stadium III in der klinischen Klassifikation, Stadium 3 in der arthroskopischen sowie Stadium A in der lokoanatomischen Klassifikation.     

A case of hypothyroidism mimicking acute coronary syndrome

Hypothyroid patients have increased concentrations of creatinine kinase that is mostly due to increased CK-MM. However, CK-MB has also been reported to increase above reference values in hypothyroid patients without apparent myocardial damage. This may create confusion during the evaluation of myocardial injury in a hypothyroid patient presenting with chest pain. Troponin I is considered as a superior marker for the diagnosis of myocardial infarction in hypothyroid patients. However, there are some reports showing an increase in the level of troponin I without any myocardial damage in hypothyroid patients as in our case. In this report, we present a 47 years old male hypothyroid patient who had chest pain, abnormal electrocardiographic findings and increased cardiac enzymes suggesting acute coronary syndrome although he had normal coronary arteriogram. Address for correspondence: Huseyin Gunduz, MD, Department of Internal Medicine and Cardiology, Izzet Baysal Medical Faculty, Izzet Baysal University, Bolu, 14100 Turkey Tel.: +90-374-217-65-20 E-mail: drhuseyingunduz@yahoo.com     

关节镜下软组织松解治疗臀肌挛缩症

目的探讨关节镜技术在臀肌挛缩症及弹响髋微创外科治疗的可行性。方法对临床病例进行对比研究,了解手术时间、伤口愈合时间、症状改善程度等指标。结果10例患者20侧病变,弹响髋2例,臀肌挛缩症8例。手术前8例不能并膝下蹲,另2例重症患者分膝也不能下蹲。手术后当天所有患者弹响消失,完全下蹲。手术后平均住院时间2.8d,无伤口血肿、神经损伤等合并症。结论关节镜下阔筋膜张肌腱膜、臀肌肌膜及肌肉内的变性束带等软组织松解治疗臀肌挛缩症及弹响髋,是一种安全、有效、美观经济的手术方法。作者创造了一种在人为分离形成的组织腔室内进行关节镜手术的外科技术。     

髓过氧化物酶与急性冠状动脉综合征的相关性研究

目的探讨冠状动脉内粥样硬化斑块不同稳定程度患者的血清髓过氧化物酶(myeloperoxidase,MPO)水平的变化。方法检测23例ST段抬高的急性冠状动脉综合征(STEACS组)患者、27例非ST段抬高的急性冠状动脉综合征(NSTEACS组)患者4、8例稳定性心绞痛(SAP组)患者以及55例对照组患者的血清MPO、肌钙蛋白T(cTnT)、高敏C反应蛋白(hs-CRP)等主要指标的水平,同时通过冠状动脉造影进行对比研究。结果ACS患者血清MPO水平明显高于SAP组和对照组,尤以STEACS组增高更显著,并随着血清MPO的增高,发生ACS的风险越大,血清MPO水平最高四分位组发生ACS的OR是最低四分位组的4.6倍(95%CI:1.6~13.4),而且比hs-CRP和绝对中性粒细胞数(ANC)预测发生ACS的风险更强;冠状动脉不同狭窄程度各组之间血清MPO水平的差异有统计学意义;cTnT<0.1μg/L患者占74.7%,且其中血清MPO水平最高四分位组发生ACS是最低四分位组的4.9倍;MPO与hs-CRP、ANC无明显相关关系,是ACS独立的危险因素。结论血清MPO水平与ACS的严重程度显著相关,尤其当cTnT水平较低时,它能早期独立预测ACS的发生。