经皮冠状动脉介入治疗时球囊扩张释放支架对心电图的影响

经皮冠状动脉介入治疗 (PCI)时 ,扩张球囊堵塞冠状动脉 ,血流中断 ,造成暂时性心肌缺血。我们通过分析PCI时球囊扩张释放支架前后心电图QRS宽度及QRS额面电轴的变化 ,探讨其在急性心肌缺血诊断中的意义。1　对象与方法选择 2 0 0 3年 6～ 1 2月在本院行PCI,并排除完全闭塞病变和经皮冠状动脉腔内成形术导丝通过狭窄病变后远端血管显影消失或基本消失的冠心病 (CHD)患者共 37例 ,其中男 2 2例 ,女 1 5例 ,年龄 45～ 73( 5 9.2± 9.8)岁。共置入 68枚支架 ,其中左前降支 38枚 ,右冠状动脉 2 5枚 ,左回旋支 5枚 ,因左回旋支例数太少被…     

在小冠状动脉中置入支架的回顾性分析

回顾性研究 1997至 2 0 0 1年我院所有小冠状动脉置入支架 (CS)资料 ,以期分析小冠状动脉中置入支架的安全性和有效性。资料与方法对象 :血管直径 <3mm者定义为小冠状动脉。 72例患者存在 84支小冠状动脉支架。男 4 9例 ,女 2 3例 ,年龄 4 9～73(5 8 6± 8 5 )岁。单支血管病变者 5 4例 ,两支小血管病变者 15例 (其中 6例合并 >3mm病变血管 ) ,三支小血管病变者 3例。左前降支 32个 ,对角支 17个 ,左旋支 19个 ,右冠状动脉 16个。 16支为经皮冠状动脉腔内球囊成形术 (PTCA)后夹层形成 ,2 1支为PTCA后回缩明显。方法 :CS置入按常规标准…     

冠状动脉慢性完全闭塞病变的临床特点分析

目的讨论冠状动脉慢性完全闭塞的治疗措施及效果。方法入选2010年1月至2013年3月江西省人民医院干部心血管一科住院的冠心病患者138例,冠状动脉造影显示为冠状动脉慢性完全闭塞(CTO)病变。回顾性分析138例CTO患者血运重建治疗措施以及效果。结果 138例CTO患者,共162支慢性完全闭塞血管,主要累及前降支(LAD)52支,回旋支(LCX)27支,左主干(LM)9支及右冠状动脉(RCA)60支。145支慢性完全闭塞血管行经皮冠状动脉腔内成行(PTCA)治疗,130支血管成功支架置入101个。17例患者行冠状动脉旁路移植术(CABG)。结论 CTO临床表现多样,但缺乏特异性,可以选用PTCA及支架术或CABG治疗。     

老年人多支冠状动脉病变的介入治疗

目的评估老年多支冠状动脉病变患者经皮冠状动脉介入治疗(PCI)的疗效和安全性。方法回顾性对照分析沈阳军区总医院677例年龄≥60岁(老年组)和547例年龄<60岁(非老年组)接受PCI并获得完全血运重建的多支冠状动脉病变患者的临床资料、冠状动脉病变特点、手术成功率、并发症及近、远期临床随访结果。结果与非老年组比较,老年组女性、合并左主干病变、慢性闭塞病变、>20mm长病变、显著钙化病变和复杂病变(B2+C 型)患者的比例及平均植入支架数均较多。两组PCI手术成功率及手术并发症发生率无显著性差异。老年组住院期间主要不良心脏事件(MACE)发生率(3．8％ vs 1.8％)及总死亡率(3．0％ vs 1．1％)均高于非老年组(P<0．05)。平均随访(11．9±3．8)个月,两组总随访率、造影复查再狭窄率、心绞痛复发率、随访患者MACE发生率及总死亡率均无显著性差异。结论老年组多支冠状动脉病变患者PCI后住院期间MACE发生率及总死亡率高于非老年组,但其 PCI成功率、手术并发症、长期临床疗效与非老年组患者相似,提示PCI是治疗老年多支冠状动脉病变安全、有效的方法。     

中青年冠心病患者危险因素、经皮冠状动脉介入治疗及特点

目的:探讨55岁以下中青年冠心病患者危险因素及经皮冠状动脉介入治疗(PCI)特点。方法:根据患者的年龄分为中青年组(<55岁患者,212例)和老年组(>70岁患者,231例),比较2组间发病的危险因素、PCI治疗特点及术后并发症情况,评估2组间PCI治疗疗效。结果:中青年组冠心病患者中男性、有阳性家族史、吸烟史、大量饮酒史者明显多于老年组(P<0.01),高LDL、低HDL中青年患者亦多于老年组患者(P<0.05);老年组冠心病患者中原发性高血压检出率高于中青年组(P<0.05),糖尿病检出率也明显高于中青年组(P<0.01)。冠状动脉造影结果显示:中青年组患者冠状动脉血管病变以单支血管病变为主,且多为轻中度、局限性狭窄,3支血管病变及左主干病变者较少,严重、弥漫性及钙化血管病变亦不多见。双支血管病变2组差异无统计学意义。2组间支架置入情况相比,中青年组患者右冠状动脉支架置入数少于老年组,差异有统计学意义。2组患者手术成功率均较高(P>0.05)。结论:吸烟、大量饮酒、冠心病家族史是中青年冠心病发病的重要危险因素,高LDL、低HDL在中青年冠心病患者发病过程中亦起到重要作用。中青年冠心病患者冠状动脉以单支血管...     

老年冠心病患者冠状动脉内支架置入术的疗效评价

目的　评价老年冠心病患者冠状动脉内支架置入术的临床疗效和安全性。方法　对比分析 49例老年 (86支血管 )和 6 1例老年前期 (98支血管 )冠心病患者冠状动脉内支架置入术的结果。结果　老年组冠状动脉病变严重、复杂病变较多 ,在复杂病变内置入支架比率高于老年前期组 ;手术即刻成功率和临床成功率均为 98.0 % ;术前病变平均狭窄率为 (94.5± 5 .6 ) % ,术后残余狭窄率为 (7.4± 8.2 ) % ;因球囊扩张不理想置入支架的为 45 .0 % ,因经皮冠状动脉腔内成形术 (PTCA)并发夹层或濒临闭塞而置入支架的比率高于老年前期组。出现严重并发症 1例(2 .0 % )。结论　老年冠心病患者冠状动脉内支架置入术成功率高 ,并发症发生率低。     

原发性冠状动脉夹层的造影特点及介入治疗

目的　了解原发性冠状动脉夹层 (SCAD)的发生情况及介入治疗的效果。方法　分析 22 16例冠状动脉造影以发现SCAD ;对适合经皮冠状动脉介入治疗术 (PCI)的SCAD患者行支架置入术 ,手术前后及手术中按要求使用阿司匹林、氯吡格雷、肝素或低分子肝素等药。结果　发现SCAD共 2 6例 ,男 19例 ,女 7例 ,平均年龄 (6 0 9± 11 6 )岁 (34～ 75岁 ) ,检出率为 1 17%。其中急性心肌梗死 15例 ,不稳定型心绞痛 11例。 2 6例患者共 2 8支血管发生SCAD。其中冠状动脉左主干 1例 ,左前降支 9例 ,回旋支 4例 ,右冠状动脉 14例。对适合PCI术的 18例患者 19支血管撕裂处行支架置入术。其中 14例 15处行经皮腔内冠状动脉成形术 (PTCA) 支架置入术 ,4例行直接支架置入术。撕裂处共置入支架 2 3枚。支架置入术后 ,1例冠状动脉原发性撕裂处残余狭窄小于 30 % ,另 1例残余狭窄小于 10 % ,其余 16例均无残余狭窄。经介入治疗后患者的临床症状均明显缓解。结论　SCAD并非罕见 ,存在冠状动脉粥样斑块者是SCAD相对高发的人群。支架置入术是治疗SCAD较为理想的方法。     

经皮冠状动脉腔内成形术在糖尿病合并心肌梗塞治疗中的应用

对35例糖尿病合并心肌梗塞病人进行冠状动脉造影，对其中30例作了经皮冠状动脉腔内成形术（PTCA），结果显示，冠状动脉血管三支病变15例，二支病变9例，单支病变11例，共80支血管，100个血管段有病变，病变呈弥漫性、长段不规则改变占41．2％。30例PTCA共41支血管，术前狭窄平均94．9±7．18％，术后残余狭窄平均12．6±11．8％，完全性血管运重建40％，部分性血管运重建53．3％，其中13支血管置入了支架，30例中3例术后死于急性全心衰和心源性休克。     

慢性完全闭塞冠状动脉病变1148例患者的介入治疗

目的　总结慢性完全闭塞(CTO)冠状动脉病变经皮冠状动脉介入(PCI)治疗的技术及疗效。方法　对1993年6月至2004年12月实施PCI治疗的1148例CTO患者的临床资料、病变特征和PCI结果进行回顾性分析。共涉及CTO靶血管1458支,靶病变1494处,CTO平均闭塞时间(49. 1±31. 6)个月,置入冠状动脉支架1499枚。结果　病例成功率为90 .2% ( 1036 /1148 ),病变成功率为88 。2% (1317 /1494)。随CTO闭塞时间延长,PCI成功率降低,闭塞部位呈刀切状、存在桥侧支、闭塞长度≥15mm的CTO病变PCI成功率降低(P<0. 05)。操作失败112例,其中82 .1%因导丝不能通过CTO病变, 17 .9%因球囊不能跨越病变。术中无死亡病例,支架内急性血栓形成2例(0. 2% ),术中及术后共发现心包穿孔9例( 0 .8% )全部处理成功。术后住院期间共死亡3例(0 .3% ),支架内亚急性血栓形成3例(0 .3% ),总的主要不良心脏事件发生率为0 .6% (7 /1148)。存活患者出院心绞痛症状缓解率为87. 1%。结论　在技术成熟的心脏中心,PCI治疗CTO病变可获得较高的成功率和较好的临床效果。     

冠状动脉内支架置入术治疗老年患者复杂冠状动脉病变

目的　探讨经皮冠状动脉腔内支架置入术治疗老年患者复杂性冠状动脉病变的疗效及安全性。方法对 4 5例冠心病患者施行冠状动脉内支架置入术 ,病变血管共 5 8支 ,B型病变 4 9处 ,C型病变 1 3处 ,慢性完全闭塞病变 4处 ,共置入支架 64只。置入左前降支 2 7只 ,左回旋支 1 3只 ,右冠状动脉 2 4只。De Novo支架置入 4 4只 ,Suboptimal支架置入 1 5只 ,Bail-out支架置入 3只 ,再狭窄病变支架置入 2只。结果　术后经冠状动脉造影证实疗效满意 ,支架置入成功率为 98.4 %。术前病变平均直径狭窄 (86.5± 7.8) % ,术后残余直径狭窄 (5 .1± 1 0 .3 ) %。住院期间无亚急性支架血栓形成。 1例出现假性动脉瘤 ,1例在术中及术后出现三次心室颤动 ,4例患者术后心绞痛复发 ,复查冠状动脉造影发现了 3个支架节段血管有再狭窄。结论　对于老年冠心病患者复杂冠状动脉病变 ,经皮冠状动脉内支架置入术是一种安全有效的介入性治疗技术 ,其成功率高 ,并发症发生率低     

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.