支架型人工血管介入治疗主动脉夹层动脉瘤及主动脉穿透溃疡30例报告

目的探讨支架型人工血管介入治疗主动脉夹层动脉瘤和主动脉穿透溃疡的可行性及疗效。方法2001年6月至2004年3月,行支架型人工血管治疗主动脉夹层动脉瘤及主动脉穿透溃疡30例。男性24例,女性6例。平均年龄(523±119)岁。25例主动脉夹层动脉瘤中,慢性TypeB23例,急性TypeB1例,TypeA1例。主动脉穿透溃疡5例。术后随诊1～32个月。结果30例支架型人工血管均成功植入。5例有近端内漏,1例术中发生升主动脉夹层,2例分别在术后1d、7d发生升主动脉夹层。术后30d内死亡2例。术后30d内死亡率为67%。1例术后20个月因近端内漏接受第2次支架型人工血管植入术。术后随诊1～32个月,无死亡,亦无支架移位、狭窄等并发症。结论支架型人工血管是治疗主动脉夹层动脉瘤和主动脉穿透溃疡的有效方法,中远期效果还有待进一步观察。     

The World Survey of Cardiac Pacing and Implantable Cardioverter Defibrillators: calendar year 1997--Europe

The registry of the European Working Group on Cardiac Pacing (EWGCP) is based on the European Pacemaker Identification Card originally designed in July 1978. National registration centers collect the local data and send aggregated annual data to the EWGCP. For 1997, data were obtained from 2,887 hospitals in 20 European countries representing a population of 568 million. Across all participating countries, the median value for all implanted pacemakers was 378 per million population. For initial pacemaker implants, the median value was 290 per million population. Single chamber atrial pacing was important in Denmark, the Netherlands, Poland, Slovak Republic, Spain, and Sweden for the treatment of sick sinus syndrome. Dual chamber pacing accounted for < 50% of initial implants in only 5 of 14 countries for atrioventricular block, and in only 3 of 15 countries for sick sinus syndrome. In 7 of 15 countries, unipolar ventricular leads were used in > or = 50% of cases. In 6 of 14 countries, there was > 15% use of unipolar atrial leads. Nine of 13 countries frequently used atrial active-fixation leads. For the 1997 survey, ICD data were obtained from 16 countries. The total number of ICDs per million population was a median value of 14. Initial ICD implants per million population was 11. Only 3 of 16 countries implanted a total of 30 or more ICDs per million population. Pacing and ICD practices were dependent on the availability of medical and technical resources and influenced by economic constraints inherent in health care administration and insurance coverage patterns.     

X-J心脏保存液对离体心脏不同保存时限ATP及超微结构的影响

目的 :探讨XIJING (X J)超极化保存液对离体兔心低温下不同保存时间再灌注 3 0min后心肌细胞ATP含量及心肌超微结构的影响。方法 :健康大白兔 3 2只 ,随机分成 4组 ,每组 8只 ,Ⅰ组 :低温保存 4h ;Ⅱ组 :低温保存 6h ;Ⅲ组 :低温保存 8h ;Ⅳ组 :低温保存 10h。每组供心均用X J超极化心肌保存液进行低温保存。测定再灌注 3 0min心肌细胞ATP含量及心室肌超微结构 ,比较不同保存时间再灌注后心肌细胞ATP及心肌超微结构的变化。结果 :随着低温保存时间的延长再灌注 3 0min后心肌细胞内ATP的含量无明显的差异 (P >0 0 5 )。从电镜观察来看 ,兔心保存 4～ 6h时心肌纤维排列尚整齐 ,线粒体轻度肿胀 ;在保存 8h后心肌纤维排列紊乱 ,线粒体嵴肿胀 ,个别线粒体出现空泡化 ;10h时心肌组织出现部分心肌细胞坏死 ,细胞器散在于细胞间。结论 :X J超极化心脏保存液在低温保存供心 4～ 6h心肌超微结构变化不明显 ,心脏保存 10h后心肌超微结构改变较 8h明显。     

Seventh survey of staffing in cardiology within the UK 1991

The Seventh Survey of Staffing in Cardiology was conducted with an index date of 31 July 1991. At that time the total number of posts for cardiologists in England and Wales, defined as individuals trained in the specialty and spending at least 40% of their professional time working in it, was 340. Ten individuals worked part time only, making 335 whole time equivalent posts. This number increased from 1990 by 15 (4·7%). There were 67 cardiologists in Scotland and Northern Ireland, making a total for the United Kingdom of 407 posts (402 whole time equivalents). Sixteen Districts in England and Wales had no cardiologist at the time of the survey, and 31 other Districts had less than seven visiting sessions each week. The situation had not improved since the 1990 survey. The population of these 47 Districts is nearly nine million. Scotland had almost 800 000 additional people served by Health Boards without resident cardiologists.

The number of senior registrars and lecturers is inadequate to provide a full period of training for most who advance to consultant status, and the situation will worsen from 1995 onwards. A major problem has been a top slice of 10 posts for a research allocation, few of which are occupied by individuals seeking a career in the specialty. These posts should be redesignated to increase training opportunities to counter the present shortfall and facilitate an expansion in consultant posts of at least 5% per annum over the next decade.

     

Physiological assessment of coronary artery disease in the cardiac catheterization laboratory: a scientific statement from the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology

With advances in technology, the physiological assessment of coronary artery disease in patients in the catheterization laboratory has become increasingly important in both clinical and research applications, but this assessment has evolved without standard nomenclature or techniques of data acquisition and measurement. Some questions regarding the interpretation, application, and outcome related to the results also remain unanswered. Accordingly, this consensus statement was designed to provide the background and evidence about physiological measurements and to describe standard methods for data acquisition and interpretation. The most common uses and support data from numerous clinical studies for the physiological assessment of coronary artery disease in the cardiac catheterization laboratory are reviewed. The goal of this statement is to provide a logical approach to the use of coronary physiological measurements in the catheterization lab to assist both clinicians and investigators in improving patient care.