急性心肌梗死患者行冠状动脉内超声溶栓的观察

目的 研究低频高能超声溶解急性心肌梗死（ＡＭＩ）上关血管血栓的有效性和安全性。方法 ＡＭＩ患３０例（梗死部位：前壁１６例,下壁１４例）。左前降支（ＬＡＤ）闭塞１６例;左回旋支（ＬＣＸ）闭塞４例,右冠状动脉（ＲＣＡ）闭塞１０例。超声溶栓后对闭塞相关血管行急诊经皮冠状动脉腔内成形术（ＰＴＣＡ）。结果 超声溶栓后闭塞相关血管达心肌梗全试验（ｔｈｒｏｍｂｏｌｙｓｉｓ ｉｎ ｍｙｏｃａｒｄｉａｌ ｉｎｆａ     

胸前导联合并Ⅱ、Ⅲ、avF导联ST段抬高的急性心肌梗死患者的临床和冠状动脉造影特点

目的：研究胸前导联合并Ⅱ、Ⅲ、avF 导联 ST 段抬高的急性心肌梗死患者的梗死相关动脉,评估其梗死面积和左心室功能减退程度,探讨如何通过心电图判断其梗死相关动脉。方法：将354例心电图表现为胸前导联 ST 段抬高的急性心肌梗死患者分为3组：A 组,胸前导联合并Ⅱ、Ⅲ、avF 导联 ST 段抬高(n=59),并根据梗死相关动脉进一步分为右冠状动脉闭塞者和左冠状动脉前降支闭塞者；B 组,单纯胸前导联 ST 段抬高(n=151)；C 组,胸前导联 ST 段抬高合并Ⅱ、Ⅲ、avF 导联 ST 段压低(n=144)。测定肌酸激酶(CK)和肌酸激酶 MB 同工酶(CK-MB),超声心动图测定左心室射血分数(LVEF),通过冠状动脉造影判断梗死相关动脉。结果：A 组的梗死相关动脉分别为右冠状动脉,约56%；左冠状动脉前降支,约37%。其中,右冠状动脉闭塞者,闭塞部位多为右冠状动脉近段,ST 段抬高幅度在Ⅲ导联＞Ⅱ导联,在V_1导联＞V_3导联；左冠状动脉前降支闭塞者,闭塞部位多为左冠状动脉前降支中远段,ST 段抬高幅度在 V_3导联＞V_1导联。B 组和 C 组梗死相关动脉几乎均为左冠状动脉前降支(分别为96%和95%)。与其他两组相比,A 组 ST 段抬高的导联数最多,但 CK-MB 峰值最低,LVEF 值最高。结论：胸前导联合并Ⅱ、Ⅲ、avF 导联 ST 段抬高的急性心肌梗死,可能是由右冠状动脉近段闭塞或环绕心尖部的左冠状动脉前降支远段闭塞引起的。其心肌梗死面积相对较小,心功能受损较少。在这些患者中,如果Ⅱ、Ⅲ、avF 导联 ST 段抬高的总幅度较大,ST 段抬高幅度在Ⅲ导联＞Ⅱ导联,在 V_1导联＞V_3导联,梗死相关动脉为右冠状动脉的可能性较     

急性冠状动脉综合征的现代治疗策略

急性冠状动脉综合征（ACS）涵盖了从不稳定型心绞痛（UA）到ST段抬高心肌梗死（MI）的一系列临床急症,常突然起病,可无先兆症状,危险性大。ACS可分为两类,即ST段抬高的ACS（Q波MI）;ST段不抬高ACS,包括ST段不抬高的MI（无Q波MI）和UA。这种分类方法简单易行,对ACS的治疗决策有指导意义。如为ST段抬高的ACS,可尽早行溶栓治疗、经皮冠状动脉腔内成形术（PTCA）或冠状动脉旁路移植术（CABG）,以使梗塞相关血管再通,     

急性心肌梗死冠脉内超声溶栓

目的研究冠脉内低频（２０ｋＨｚ）、高强度（４０Ｗ）超声溶栓在急性心肌梗死梗塞相关血管中的应用。方法急性心肌梗死患者１１例（前壁心梗６例,下壁心梗５例）,梗塞相关血管前向血流均为ＴＩＭＩ０级和１级（左前降支６例,左回旋支２例,右冠状动脉３例）,超声溶栓后行急诊经皮腔内冠状动脉成形术（ＰｒｉｍａｒｙＰＴＣＡ）。结果冠脉内超声溶栓对梗塞相关血管的开通率为７３％（血流达ＴＩＭＩ３级）,残余狭窄为（７２±１４）％,１１例全部立即行ＰＴＣＡ,超声溶栓失败的３例经ＰＴＣＡ后血管全部开通,ＰＴＣＡ术后残余狭窄为（２４±１２）％。冠脉内超声溶栓时,因超声探头折断,血管再度闭塞１例,冠脉轻度撕裂１例;无血管痉挛,无远端血管栓塞等并发症,也无室速、室颤等恶性事件发生。结论本研究表明冠脉内低频、高强度超声溶栓是安全、有效的血管开通方式,可应用于临床。     

心肌梗死后不同时期内梗死相关动脉病变情况分析

目的总结分析心肌梗死后不同阶段患者的梗死相关动脉的闭塞情况。方法回顾性分析自2005年6月至2011年6月在我科住院行选择性冠状动脉造影的心肌梗死患者1 524例的临床资料,根据患者行冠状动脉造影的时间和心肌梗死类型将所有的患者分为4组:24 h内急诊冠状动脉造影的ST段抬高型急性心肌梗死组(急诊CAG STEMI组)、7天至2周内行择期冠状动脉造影的ST段抬高型急性心肌梗死组(择期CAG STEMI组)、陈旧性心肌梗死组(OMI组)、3天内行冠状动脉造影的非ST段抬高型急性心肌梗死组(NSTEMI组)。通过分析各组的影像学资料,观察梗死相关动脉分布和闭塞情况。结果各组梗死相关动脉的分布情况为:急诊CAG STEMI组中,左前降支的发生率明显高于其他梗死相关动脉;择期CAG STEMI组中,左前降支和右冠状动脉仍高于其余梗死相关动脉;OMI组中,各梗死相关动脉无明显差别;NSTEMI组中,左前降支和左回旋支高于其余动脉。各组梗死相关动脉的闭塞情况为:急诊CAG STEMI组高于择期CAG STEMI组、OMI组、NSTEMI组(P<0.001),OMI组高于择期CAG STEMI组、NSTEMI组(P<0.01),择期CAG STEMI组与NSTEMI组比较差异无显著性。结论梗死相关动脉为左回旋支时常不能及时发现就诊,需要提高对梗死相关动脉为回旋支的心肌梗死患者的识别和及时治疗。ST段抬高型急性心肌梗死患者1～2周后闭塞率明显降低,近一半的患者达到TIMI 2～3级血流。非ST段抬高型急性心肌梗死患者梗死相关动脉的闭塞率较低,可能是无ST段抬高的原因之一。     

冠状动脉血管成形术治疗非ST段抬高的急性冠状动脉综合征

非ST段抬高的急性冠状动脉综合征 (ACS)是指冠心病不稳定型心绞痛 (UAP)和非Q波型急性心肌梗死 (NQMI)。2 0世纪 90年代中期以来 ,随着对非ST段抬高的ACS发病机理的深入研究 ,对它的治疗取得了较大的进步。本文对冠状动脉血管成形术治疗非ST段抬高的ACS的进展进行综述。一、冠状动脉血管成形术治疗非ST段抬高的ACS1 直接冠状动脉血管成形术治疗非ST段抬高的ACS :指在非ST段抬高的ACS患者发病早期 (2 4～ 4 8h)行常规冠状动脉造影 ,若无禁忌证 ,同时行冠状动脉血管成形术 ,包括经皮冠状动脉介入治疗 (PCI)或冠状动脉旁路移…     

急性冠状动脉综合征患者再灌注策略的选择

急性冠状动脉综合征(ACS)是由于冠状动脉血管内不稳定的脂质斑块破裂、出血,造成血管内血栓形成或冠状动脉痉挛,最终导致管腔狭窄或闭塞,从而引起一系列病理生理变化。根据心电图ST段是否抬高,将ACS分为非ST段抬高ACS和急性ST段抬高型心肌梗死(STEMI)[1],因两者病理生理改变不同,所以其治疗策略存在差异。     

急性冠状动脉综合征的急诊介入治疗

目的评价急诊冠状动脉内介入治疗急性冠状动脉综合征的疗效和安全性。方法急性冠状动脉综合征患者87例,男72例,女15例。年龄37～82岁。其中ST段抬高心肌梗死62例,非ST段抬高心肌梗死和不稳定型心绞痛25例,行急诊冠状动脉内介入治疗,分析其临床表现,冠状动脉病变特点,处理以及并发症和预后。结果87例患者共成功置入支架169枚,其中直接支架术53次,经皮冠状动脉腔内成形术加支架术116次。单纯冠状动脉腔内成形术22次。有16例患者行血管内超声指导冠状动脉内介入。手术成功率96．5％,住院期间死亡1例。随访5～22月,生存率98.8％,无事件生存率86．0％。院外猝死1例,心肌梗死1例,心绞痛再发10例。结论急诊冠状动脉内介入治疗急性冠状动脉综合征安全有效,有助于改善预后。     

(2) 急性冠状动脉综合征的介入治疗

急性冠状动脉综合征(acute coronary syndrome,ACS)包括Q波性急性心肌梗死(AMI),非Q波性AMI和不稳定性心绞痛.他们的主要发病机制都是在斑块破裂的基础上诱发急性血栓形成,如果形成急性闭塞性血栓则主要造成ST段抬高的Q波性AMI,如果血栓为非闭塞性或虽为闭塞性,但其远端已有侧支循环形成,多造成非Q波性AMI或不稳定性心绞痛,统称为无ST段抬高的ACS.梗死相关冠状动脉血栓性闭塞率在ST段抬高的AMI、无ST段抬高的AMI和不稳定性心绞痛中分别占90%、20%～40%和10%左右.对于ST段抬高的AMI直接急诊介入治疗明显优于溶栓治疗的疗效已成定论.对于无ST段抬高的ACS患者是否常规急诊介入治疗,其疗效是否优于内科药物治疗,目前尚无定论.     

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急性冠状动脉综合征(acute coronary syndrome,ACS)的共同病理生理特征是冠状动脉内的粥样硬化斑块不稳定,发生溃疡、破裂,局部血小板激活聚集,形成血栓,导致血管完全或不完全的闭塞,持续时间可长可短,导致供血的心肌缺血甚至坏死。这就决定了在ACS的治疗中,抗凝和抗血小板药物起着非常重要的作用。根据心电图ST段抬高与否将ACS分类是ACS现代治疗策略中重要的基本概念。ST段抬高的心肌梗死(STEMI)的病理基础是导致管腔完全闭塞的红色血栓,而非ST段抬高的急性冠状动脉综合征(NSTEACS)则为非闭塞性的白色血栓。基于此,对于STEMI…     

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.