静脉应用地尔硫卓和美托洛尔治疗老年心功能衰竭伴心房颤动快速心室率的疗效和安全性比较

目的比较在中重度心功能衰竭伴心房颤动快速心室率的老年患者静脉注射地尔硫卓和美托洛尔控制心室率的有效性和安全性。方法采用随机单盲方法,将72例中重度心功能衰竭伴心房颤动快速心室率的老年患者分为2组,分别给予地尔硫卓和美托洛尔静脉注射,观察有效率及血压、症状和体征变化。结果地尔硫卓组有效率为94.6%,用药前心室率为149±26次/min、用药后120min降至97±19次/min,下降幅度为35%;美托洛尔组有效率为97.1%,用药前后心室率分别为150±27、95±18次/min,下降幅度为37%。两组血压均有下降但多在正常范围,地尔硫卓组无心功能恶化,美托洛尔组1例心功能恶化。结论静脉注射地尔硫卓和美托洛尔均能有效地控制老年中重度心功能衰竭患者的心房颤动快速心室率,且相对安全。     

美托洛尔注射液与西地兰控制快速心房颤动的疗效比较

目的观察静脉用美托洛尔与毛花甙C（西地兰）控制快速心房颤动（房颤）心室率的疗效和安全性。方法将70例快速房颤患者随机分为两组,美托洛尔组36例,稀释后缓慢静脉注射美托洛尔5mg,观察5分钟,如无效重复1次,连续用药3次,总量15mg;西地兰组34例,稀释后缓慢静脉注射西地兰0．4mg,观察10分钟,如无效追加0．2mg,连续用药3次,总量0．8mg。记录用药前后心室率和血压变化,比较在各观察时间点上的有效率。结果平均起效时间美托洛尔组[（10．1±7．6）分钟]较西地兰组[（40．8±12．4）分钟]明显缩短,心室率下降幅度美托洛尔组（36．5％）较西地兰组（26．3％）明显增大,在60分钟内各观察时间点的治疗有效率美托洛尔组（47％、69％、83％、91％）明显高于西地兰组（9％、15％、35％、59％）,均无严重不良反应发生。结论美托洛尔注射液较西地兰控制快速房颤心室率更快速、有效、安全。     

老年肺心病心衰伴快速房颤的临床疗效观察

目的:比较老年肺心病中重度心功能衰竭伴快速房颤的患者静脉注射地尔硫卓及西地兰控制心室率的临床疗效和安全性.方法:采用随机单盲方法,将60例老年肺心病合并中重度心功能衰竭伴快速房颤患者分为2组,分别给予地尔硫卓和西地兰静脉注射,观察控制心室率的有效率及临床症状和体征的变化.结果:地尔硫草组控制心室率有效率为93.6%,西...     

美托洛尔静脉注射治疗快速心房颤动疗效评价

目的:观察美托洛尔(商品名:倍他乐克)注射液治疗快速心房颤动(房颤)的疗效及安全性。方法:42例快速房颤患者随机分为美托洛尔组与西地兰组,美托洛尔组21例予美托洛尔注射液5～15mg静脉注射,西地兰组21例予西地兰注射液0.4～0.8mg静脉注射,分别观察治疗前及治疗后40min、60min及120min患者心率及血压的变化。结果:1.2组患者分别有12例和8例在120min内心室率降至<100次/min,2组比较差异无显著性(57.14%vs38.09%,P>0.05)。2.美托洛尔组患者心室率降至<100次/min所需的时间为(18.33±12.31)min,西地兰组心室率降至<100次/min所需的时间为(65.00±35.05)min,2组比较差异有显著性(P<0.01)。3.美托洛尔静注起效平均时间(14.00±9.95)min,西地兰静注起效平均时间为(62.50±41.66)min,二者比较差异有显著性(P<0.01)。4.美托洛尔组总有效率85.71%(18/21),西地兰组总有效率47.62%(10/21),2组比较差异有显著性(P<0.01)。5.美托洛尔组治疗主要不良反应为低血压,无心力衰竭及严重心律失常。结论:美托洛尔静脉注射治疗快速房颤安全有效,为急诊科治疗快速房颤的可靠方法。     

地尔硫(艹卓)在急诊控制心房颤动快速心室率中的应用

目的观察比较静脉注射地尔硫(艹卓)、毛花甙C控制急诊心房颤动快速心室率即时疗效比较及安全性.方法71例急诊心房颤动伴快速心室率患者随机分成2组,分别静脉注射地尔硫(艹卓)或毛花甙C.结果地尔硫(艹卓)、毛花甙C二组控制心房颤动快速心室率总有效率为93.5%,72.9%;心室率平均下降幅度分别为36%、28%;平均起效时间为6.5±3.4min、24±16.5min.地尔硫(艹卓)组有2例出现一过性低血压,可自行恢复.结论静脉注射地尔硫(艹卓)10mg,10～15mg/h维持静脉滴注对心房颤动快速心室率的控制安全、迅速、有效.     

地尔硫(艹卓)与西地兰-D对心房颤动心室率的控制及其对房室传导的影响

目的:比较地尔硫革(Diltiazem)及西地兰-D对心房颤动(房颤)心室率控制的安全性和有效率以及对传导系统的影响。方法:对43例房颤患者随机地接受0.4mg西地兰-D(n-22)或0.25mg/kg地尔硫(?)(n=21)。120 min时无效者重复同剂量地尔硫(?)或0.2 mg西地兰-D。记录用药前后5、10、20、30、60 min的心室率及血压。无效者观察120 min及第2次用药者180 min的心室率及血压。19例窦性心律患者随机分为西地兰-D(n=10)和地尔硫(?)(n=9)组行希氏束电图检查测量PA、AH、HV间期而评估西地兰-D及地尔硫(?)对传导系统的影响。记录药物注射前及注射后的5、10、20、30 min的希氏束电图。结果:地尔硫(?)及西地兰-D组中180min内能有效控制心室率分别为20及15例(95.2％:68.2％,P<0.05)。地尔硫(?)及西地兰-D均延长AH间期,但对PA、HV问期无影响。结论:地尔硫(?)及西地兰-D均能减慢房颤心室率,但地尔硫(?)的有效率、心室率下降幅度优于西地兰-D。地尔硫(?)对心室率快的房颤伴充血性心力衰竭患者是一种较为合适的药物,在密切监护下应是安全的。两药均不影响HV、PA间期而通过延长AH间期减慢心室率。     

静脉地尔硫(卓)治疗老年人快速心室率房颤、房扑和室上速的临床观察

目的　观察静脉地尔硫艹卓 对老年人快速心室率的房颤、房扑及室上速的疗效与安全性。方法　 1 5例患者 (7例房颤、3例房扑、5例室上速 )静脉注射地尔硫艹卓 1 0～ 1 5mg,有反应者继以 1 0～ 1 5mg/ h浓度持续静点 6～ 1 2 h。结果　用药后心室率比用药前基础心率减少 >2 0 % ;转复为窦性心律或心室率 <1 0 0次 / min为治疗有反应 ,本组 1 5例患者 1 2例 (80 % )有反应 ;用药后心室率下降最大效应时间 1 1 min,心室率下降幅度 42± 1 6次 / min。结论　地尔硫艹卓 能安全地应用于快速心室率的房颤或房扑及室上速的老年人 ,并在大多数病人能迅速有效地达到心率的控制和中止室上速的发作 ,而且不会引起或加重心功能障碍。     

控制快速房性心律失常心室率即时疗效临床用药体会

目的　观察并比较静脉注射毛花甙C、艾司洛尔及地尔硫艹卓控制快速房性心律失常心室率的有效性。方法　将2001-03~2003-08中国医学科学院阜外心血管病医院94例快速房性心律失常(房颤、房扑、房速)患者随机分为3组,分别静脉用毛花甙C(29例)、艾司洛尔(30例)和地尔硫(35例)。结果　毛花甙C、艾司洛尔和地尔硫均能有效控制快速房性心律失常的心室率,心室率下降幅度分别为30 .4%、29.3%和27. 6%,总有效率分别为86%、83%和85%,平均用药有效时间分别为( 34. 3±21 .0 )min、( 10. 0±3. 9 )min和( 10 .0±3. 9 )min。结论　艾司洛尔、毛花甙C及地尔硫艹卓均能有效、迅速、安全控制快速房性心律失常的心室率。     

静脉注射不同剂量盐酸地尔硫卓治疗快室率心房纤颤的观察

目的:探讨静脉应用不同剂量地尔硫卓治疗快速心房纤颤的临床疗效和安全性。方法:100例快速心房纤颤(排除预激综合征合并房颤)患者,设对照组(18例),研究组按地尔硫卓0.05mg/kg(20例)、0.15mg/kg(22例)、0.25mg/kg(22例)、0.35mg/kg(18例)四种不同剂量于3min内静脉注射,观察用药时、后患者心率、血压、心电图及临床症状。结果:不同剂量地尔硫卓对快速心房纤颤作用随剂量增加而增大,以0.25mg/kg显效率最大(90.9%),较0.05mg/kg组、0.15mg/kg组显著(P分别<0.01,<0.05),且起效时间短,临床症状明显改善(P<0.01);血压随剂量增加而逐渐下降。未发生严重副作用,无一例发生房室传导阻滞和窦性停搏。结论:静脉注射地尔硫卓可以迅速控制心房纤颤的心室率,疗效以0.25mk/kg为最佳,安全可靠。     

静脉注射地尔硫与毛花甙-C控制快速房性心律失常心室率即时疗效和安全性的对比观察

目的　观察和比较静脉注射地尔硫、毛花甙C控制快速心房颤动 (房颤 )和心房扑动(房扑 )心室率的即时疗效及安全性。方法　 5 4例快速房颤或房扑患者 ,采用随机方式分两组 ,分别静脉注射地尔硫、毛花甙C。结果　地尔硫、毛花甙C组控制房颤或房扑的快速心室率总有效率分别为 :94 %、70 % ,心室率平均下降幅度分别为 :3 4%、2 3 % ,平均起效时间分别为 :( 7 1± 4 2 )分钟、( 3 2 8± 2 2 8)分钟。地尔硫组出现可耐受性低血压 2例 ,发生窦性停搏 1例 ,均自行缓解 ,无心力衰竭加重表现。结论　静脉注射地尔硫能迅速、安全、有效地控制房颤、房扑的快速心室率。     

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.     

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.     

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.     

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.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.