不纯性心房纤颤(扑动)与左、右心房扩大的关系

目的 探讨不纯性心房纤颤(简称不纯性房颤)或不纯性心房扑动(简称不纯性房扑)与左、右心房扩大的关系.方法 在67例患者体表12导联心电图上V1导联以颤动波(扑动波)为主,当中夹以短暂的扑动波(颤动波)诊断为不纯性房颤(房扑).每个患者的左、右心房均经彩色超声心动图检查.结果 67例患者的双心房内径均在32 mm以上,无l例在30 mm以下.其中37例双房内径均在41 mm以上,61 mm以上左心房23例、右心房3例.在44例不纯性房颤中41～100 mm左心房40例、右心房22例.在23例不纯性房扑中,41～100 mm左心房21例、右心房9例,且无1例超过61 mm.结论 在不纯性房颤(房扑)中,左、右心房均增大,左房增大更多.     

心房静止

目的 对5例经心内电生理检查证实为完全或部分心房静止患者的表现进行总结，并对诊断中存在的问题进行分析。方法对5例患者的临床表现、心电图、食管心电图及心内电生理检查的资料进行分析。结果5例患者临床均考虑为心肌病变；4例心脏超声及心脏X线检查提示心脏普遍扩大；4例心电图无心房电活动，1例心电图见杂乱小波；3例心电图为宽QRS波，2例为窄QRS波形；3例行食管电图记录，1例为心房扑动(房扑)，2例无心房电图，4例右房内多部位均记录不到心房电图，1例低位右房及冠状静脉窦口附近记录到振幅较低的房扑波；5例右房多个部位S～10V刺激均心房不应；1例窄QRS波者心内HV同期延长，另1例窄QRS波者未记录到H波．仅见V波。结论 心房静止可以是持续性的，也可以是间歇性的；心房静止可以是全部的，也可以是部分的；心房静止体表心电图记录不刊心房波；心内电生理检查是诊断心房静止所必需的．完全的心房静止在左右房心内电图均记录不到心房波，而部分心房静止可在心房内局部记录到心房波；较高强度的心房刺激不能产生心房激动波是所有心房静止的共同特点。     

存在自发疤痕心房扑动患者的电生理特征及消融预后

目的:探讨存在自发疤痕的心房扑动(房扑)患者的电生理特征及消融效果。方法:对我科2014-2016年行电生理检查及射频消融的房扑患者进行筛查,所有房扑消融患者消融前均行冠状动脉(冠脉)造影或冠脉CTA检查,进一步行心脏电生理检查,并在三维电解剖指导下行射频消融。消融前行电激动标测及电压标测。共12例房扑患者标测到自发疤痕,其中7例右房房扑于右房标测到自发疤痕,5例左房房扑于左房标测到自发疤痕。结果:右房房扑组疤痕占总心房比例显著高于左房房扑组[(11.1±11.7)%∶(7.8±2.8)%,P0.05]。右房房扑组消融急性成功率为85.7%,左房房扑组为100%,两组差异无统计学意义。随访中,3例右房房扑患者房扑复发,第2次电压标测提示疤痕较前增加;1例左房房扑患者复发,未见疤痕增加;3例右房房扑患者出现窦房结功能障碍,需行永久起搏器植入,左房房扑患者无起搏器植入者。结论:自发疤痕可能成为心房扑动的机制,但也可能为旁观者。与左房房扑比较,存在自发疤痕的右房房扑可能进展至窦房结导致病窦综合征,需安置起搏器。     

三腔起搏器的临床应用

应用三腔起搏器治疗病窦以及同时有房室传导异常合并快速房性心律失常患者６例,其中５例为阵发房颤,１例为阵发房扑,心电图示房间阻滞。植入冠状窦电极及普通右房和右室电极,用Ｙ型转换器以右房耳电极为负极,冠状窦电极为正极构成新的双极电极。将４例患者ＤＤＤ起搏器调至ＡＡＴ模式,２例患者为ＤＤＤ模式,房性快速心律失常消失。随访２～６个月,疗效满意。三腔心脏起搏器适用于治疗病窦并有房室传导异常合并房内阻滞的阵发房扑和房颤的患者。     

心房分离的电生理特征及射频消融治疗

目的 报告一例罕见的心房分离，探讨其发生原因有助于加深对心房扑动(房扑)、心房颤动(房颤)发生机制的认识。方法 心内电生理检查，常规导管放置，测定各部位不应期，诱发房扑、房颤．并对其进行标测，用经典方法消融房扑。结果 本例心房分离表现为右房房颤、左房房扑，心室受右房房颤所控制。射频消融后，房扑不能诱发，同时心房分离现象亦消失。结论 心房分离可能由心房之间不应期不同所致，左右心房自我保护性阻滞使各自节律得以维持。对于房扑始动的心房分离，可经射频消融成功。     

双房三腔心脏起搏治疗的临床应用

4例患者,均为男性,年龄分别为33～72岁。扩张型心肌病1例,心功能Ⅳ级;2例阵发性心房颤动(简称房颤),分别由高血压病和冠心病引起。4例植入的起搏器、导线及Ｙ型接头均为Ｍｅｄｔｒｏｎｉｃ公司生产。2例阵发房颤者安装7964ｉ型具有自动模式转换功能的ＤＤＤ起搏器,2例为7864型ＤＤＤ起搏器。冠状窦导线为2188型专用双极起搏电极导线,选用586638ＭＹ型连接器,右房和右室电极为常规普通翼状电极。行左锁骨下静脉穿刺植入电极导线,右室、冠状窦及右房电极分别放于右室尖、冠状窦中部或远端及右心耳。冠状窦电极与连接器阳极相连,右房电极与连接…     

孤立永存左上腔静脉畸形患者植入起搏器一例

患者男性74岁,因窦性停搏拟植入DDDR起搏器,术中发现孤立永存左上腔静脉畸形。心脏内科与心脏外科联合手术,拟经胸部小切口在胸腔镜引导下放置右房和右室心外膜电极。术中发现右室被脂肪组织包绕,被迫植入右室心内膜电极。直视下切开右房,以自行改造的心房引流管作为导引鞘管,在食管彩色超声引导下成功植入右室心内膜电极,心房电极缝于右房侧壁。术后患者恢复良好,随访起搏参数正常。     

左心房扩大与房颤的关系

为了解左心房扩大到什么程度出现房颤及心房扩大是否都出现房颤,我们对105例超声心动左心房扩大的患者,进行了心电图对比分析。1.不同疾病左房扩大程度不同,产生机制不同:①风心病房颤的产生机理与左房扩大、肥厚、缺血而致心房肌传导时间延长,长期左房高压及左     

经右房间隔下部-右室心尖部行DDD起搏治疗顽固性起搏器综合征一例

患者男性 ,5 8岁 ,18年前因病窦综合征行VVI起搏器置入 ,后因电极脱位而自成AAI起搏 ,于 1年前更换起搏器时 ,心房电极因阻抗过高 ,再次置入心房电极不能起搏而改为VVI起搏 ,术后出现起搏器综合征。经电生理检查 ,证实右房上部无A波 ,冠状窦口可记录到A波 ,并可行心房起搏。右室起搏时为室房 1∶1逆传 ,此为起搏器综合征的机制。故保留原右室电极 ,于冠状窦口加心房螺旋电极固定 ,DDD起搏成功 ,起搏器综合征消失。     

经右房间隔下部—右室心尖部行DDD起搏治疗顽固性起搏器综合征一例。

患者男性，58岁，18年前因病窦综合征行VVI起搏器置入，后因电极脱位而自成AAI起搏，于1年前更换起搏器时，心房电极因阻抗过高，再次置入心房电极不能起搏而改为VVI起搏，术后出现起搏器综合征。经电生理检查，证实右房上部无A波，冠状窦口可记录到A波，并可行心房起搏。右室起搏时为室房1：1逆传，此为起搏器综合征的机制。故保留原右室电极，于冠状窦口加心房螺旋电极固定，DDD起搏成功，起搏器综合征消失。     

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.     

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.     

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.     

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.