胺碘酮治疗心律失常的长期耐受性

胺碘酮是非常有效的广谱抗心律失常药物,但最近的一些研究发现它有多种毒副作用。作者复习5年内242例(男155例,女87例)因室上性心律失常(156例)或室性心律失常(86例)接受口服胺碘酮治疗的病人,评价这种治疗的长期疗效。本组多数病例胺碘酮的负荷量为每日600～1,800mg,用1～4周;维持治疗是经验性的,室性心律失常通常为400mg/d,     

大剂量口服的胺碘酮负荷量:电生理作用和临床耐受性

尽管胺碘酮对治疗危及生命的室性心律失常是一种有效的药物,但口服的标准负荷量方案至今尚未确定,为了弄清胺碘酮的负荷量,患者常需延长住院时间。大剂量(>1,800mg/d)的口服负荷量,通常仅用于伴有频繁的室性快速性心律失常发作的不稳定患者。因而有必要研究:(1)大剂量口服胺碘酮负荷量对比较稳定患者的临床和电生理作用;(2)确定其安全性或耐受性,是否有可能缩短负荷期和减少住院时间。 16例过去有反复发作的室性心律失常     

胺碘酮对恶性室性心律失常QT离散度的影响

目的观察胺碘酮对恶性室性心律失常QT离散度的影响。方法观察60例恶性室性心律失常患者服用胺碘酮治疗前后校正的QT离散度（QTcd）的变化。结果应用胺碘酮治疗恶性室性心律失常（LownⅢ级以上）后与治疗前相比较，显著减少（P〈0．05），QTcd亦有显著性下降（P〈0．01），并未发现该药具有严重毒副作用。结论胺碘酮治疗恶性室性心律失常安全有效，能缩小QT离散度，从而减少室颤的发生，可降低恶性严重室性心律失常和心源性猝死。     

胺碘酮治疗顽固性室性心律失常临床分析

目的进一步了解顽固性持续性室性心律失常的易致因素及用胺碘酮治疗的效果和安全性。方法38例顽固性室性心律失常患者，首次静脉注入胺碘酮3～5mg／kg，随后以1．0～1．5mg／min维持24h，可同时口服胺碘酮600～1200mg／d，观察疗效。结果总有效率为89．5％，4例无效，未见严重致心律失常作用，心功能不全无加重。结论室壁瘤合并严重心功能不全是顽固性室速的主要原因，大剂量胺碘酮治疗顽固性持续性室性心律失常、有效。     

胺碘酮治疗高龄室性心律失常患者最佳剂量探讨

目的用不同剂量胺碘酮治疗70岁以上室性心律失常患者,以探讨高龄患者胺碘酮最佳剂量.方法47例患者随机分为A、B两组,A组:胺碘酮600mg/d×14d,减至400mg×14d,再减至200mg/d×14d,最后以100mg/d维持;B组:600mg/d×7d,减至400mg/d×7d,再减至200mg/d×7d,再减为100mg/d×7d,最后以50mg/d维持.结果A、B两组总有效率分别为82%、80%,两组无显著性差异,A组有6例发生不良反应,B组除2例轻度窦性心动过缓外,无其他不良反应发生.结论低剂量胺碘酮对70岁以上高龄室性心律失常患者不失为一种安全、有效的药物.     

静脉用胺碘酮治疗顽固性室速14例疗效观察

对14例经用1～3种常规抗心律失常药无效的顽固性室性心动过速(室速)患者,静脉应用胺碘酮,首剂150mg,继之以0.4～1.5mg/min维持1～6d(平均3.2d);同时口服胺碘酮600mg/d,必要时间隔15min重复静脉注射(静注)75～150mg,24h总量平均为1855mg.12例取得满意疗效,未见严重毒副反应.提示静脉用胺碘酮对顽固性室速治疗,安全有效.     

胺碘酮治疗心力衰竭合并室性心律失常的疗效观察

目的观察胺碘硐治疗心力衰竭合并室性心律失常的临床疗效。方法选择135例心功能Ⅱ～Ⅲ级伴室性心律失常患者,随机分成治疗组和对照组,两组均给予抗心力衰竭及改善心律失常的常规药物治疗,治疗组加服胺碘酮600mg/d,共7d,继之400mg/d,共7d,然后200mg/d维持,观察终点为心功能改善情况、室性心律失常恶化、心脏猝死,疗程为3个月,治疗前后均记录心电图、心脏彩色超声、X线胸片、肝肾功能及甲状腺功能等。结果治疗组总有效率为91.4%,对照组86.2%,两组比较差异有统计学意义（P〈0.05）;病死率治疗组为2.9%,对照组为6.2%,两组比较差异有统计学意义。结论在常规治疗的基础上,应用胺碘硐治疗心力衰竭并室性心律失常安全有效、不良反应少,近期预后良好。     

恶性室性心律失常的胺碘酮治疗

观察静脉与口服联合应用胺碘酮对恶性室性心律失常的作用。31例室性心动过速 (VT)和 /或心室颤动 (VF)患者 (男 21例,女 12例,年龄 48±14. 6岁),首剂静脉注射胺碘酮 150 ~300mg, 10min注入。继之以 0. 5~1. 0mg/min维持静脉泵入。静脉维持用药24~48h后给予口服胺碘酮 600mg/d,逐渐减量至 200mg/d维持。观察静脉用药期间的心率,QT间期,VT、VF的发作情况。结果: 22例于用药后 24h获得控制, 6例于 48h后获控制, 3例于 72h后获得控制。静脉用药期间,未见QT间期明显延长。结论:静脉用胺碘酮治疗恶性室性心律失常安全有效。静脉与口服联合给药起效快,可达到早期抢救生命的目的,又可稳定血药浓度,防止心律失常的复发。     

胺碘酮治疗维吾尔族器质性心脏病人室性心律失常的疗效和安全性

目的评价胺碘酮治疗维吾尔族器质性心脏病人室性心律失常的疗效和安全性.方法观察47例维吾尔族器质性心脏病人采用胺碘酮治疗室性心律失常的疗效和安全性,随访1～3年. 结果6例反复发作的持续性室速、室颤病人,首剂3～5 mg/kg胺碘酮10 min内静脉注射,再以1～1.5 mg/min缓慢滴注,室速均被有效终止.以200mg/d胺碘酮作为长期维持量能有效的控制室性早搏(92.7%).6例静脉注射胺碘酮病人中窦性心动过缓5例、PR间期延长1例;在41例长期口服维持量的病人中甲状腺功能低下者1例、窦性心动过缓18例、QT间期延长22例,但无肺损害发生. 结论采用胺碘酮治疗维吾尔族器质性心脏病人室性心律失常效果满意,安全可靠.     

充血性心力衰竭并有室性心律失常应用胺碘酮的经验

目的总结充血性心力衰竭(CHF)并有快速室性心律失常患者应用胺腆酮的疗效及安全性.方法26例有器质性心脏病,心功能(NYHA)Ⅱ～Ⅲ级,左心室射血分数(LVEF)0.24±0.07,伴有室性心动过速(VT)和(或)心室颤动(VF)的患者.应用静脉注射胺碘酮首剂3～5 mg/kg,稀释后10分内注入,继以0.75～1.00rmg/min维持注射,必要时可每隔30分追加胺碘酮75～150 mg,同时口服胺碘酮每日600～800mg.并逐步减至每日200mg维持.出院后随诊观察.结果第1个24小时,18/26例心律失常获控制占69%,静脉注射胺碘酮1248.0±135.4mg(1156～2184mg),56小时心律失常全部被控制,血液动力学稳定.患者心功能改善至LVEF 0.33±0.09.结论静脉注射胺碘酮治疗CHF伴VT和(或)VF安全有效,用药强调个体化,预防心律失常发作需长期口服胺碘酮.     

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.     

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.     

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.     

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.