肥厚型心肌病患者的心电图特点分析

目的探讨肥厚型心肌病(HCM)患者的心电图特点。方法 36例已确诊的HCM患者,按肥厚部位分为室间隔肥厚21例,游离壁肥厚3例,心尖部肥厚6例,全心弥漫性肥厚6例,分析其心电图特点。结果 ST-T改变最多34例(94.4%),ST段下移的程度在4型间差异无统计学意义(P0.05),T波倒置振幅超过0.5 mV者26例(72.2%),T波倒置在心尖肥厚组多于间隔肥厚组(P0.05)。异常Q波13例(36.1%),病理性Q波多出现在室间隔肥厚型患者中,间隔肥厚为主患者中,11例(52.4%)存在病理性Q波,心尖肥厚、单纯游离壁肥厚组均仅1例心电图存在病理性Q波。结论 HCM患者的心电图表现呈多样性,特异性不高,但敏感性较高。ST段改变、T波倒置、异常Q波是肥厚型心肌病患者的主要心电图表现。     

心尖肥厚型心肌病患者心电图的诊断意义

目的探讨心尖肥厚型心肌病患者的心电图特征性改变及临床诊断意义。方法分析38例心尖肥厚型心肌病患者的心电图及超声心动图资料。结果心尖肥厚型心肌病合并有心电图异常和超声心动图异常改变者38例(100%),其中伴胸前导联巨大倒置T波≥0.2mV～0.3mV,以V3～V4最明显29例(76%);左胸V4～V6导联R波电压增高,且RV4>RV5>RV6者26例(68.4%);ST段压低,以V3～V4最明显者29例(76%);超声心动图示心尖部肥厚达15mm或以上伴心尖部心腔狭小者38例。结论心电图对心尖肥厚型心肌病具有早期诊断价值和预测意义。     

有无病理性Q波肥厚型心肌病的心电和心超检查比较

目的 研究无病理性Q波的肥厚型心肌病患者的特征。方法 以心电图上是否出现病理性Q波将86例肥厚型心肌病患者分两组对其心电、超声特征进行分析。结果 86例中无病理性Q波患者49例，占57％。与病理性Q波组相比，无病理性Q波组中非对称性室间隔肥厚型较少，而对称性肥厚型较多，室间隔增厚较轻，心电图上出现左室肥厚者较多。而心电图上ST段压低下、T波倒置、超声心动图上E／A比值＜1及二尖瓣返流两组相似。结论 无病理性Q波的肥厚型心肌病并非少见，其室间隔肥厚较轻，心电图上左室肥厚检出率较高。     

心尖肥厚型心肌病的心电图对比观察

目的　观察心尖肥厚型心肌病 (AHCM )与其他类型的肥厚型心肌病 (HCM )的心电图改变。方法　对 87例HCM(B组 )者行彩色多普勒超声心动图 (UCG)及心电图检测 ,对比 1 6例AHCM组 (A组 )与 71例HCM组 (B组 )的心电图ST段压低、T波倒置、传导阻滞、病理性Q波、左室高电压、WPW的发生率。结果　A组与B组的病理性Q波、巨大倒置T波的发生率存在显著性差异 (P <0 0 5 )。结论　A、B组两组之间虽然心电图及其它方面存在许多共性 ,但病理性Q波以及巨大倒置T波的存在与否 ,对两种HCM的心电图改变有鉴别诊断价值。     

肥厚型心肌病出现巨大倒置T波的临床意义

日本学者曾描述一种伴有巨大倒置 T 波的、局限于心尖部的肥厚型心肌病。本研究以西方病人为对象,比较伴有和没有巨大倒置T 波的肥厚型心肌病的临床、二维超声心动图、放射性同位素心室显像以及48小时动态心电图的特征。方法 A 组27例病人伴有而 B 组56例病人没有巨大倒置 T 波(波幅≥10mm)。临床特征包括诊断时年龄、家族史、胸疼,呼吸困难和昏厥等。在心电图上观察左室肥厚程度、有无右室肥厚以及异常 Q 波。二维超声心动图评价左室壁厚度、心室大小、室间隔不对称     

心尖肥厚型心肌病病人MRI表现及心电图特点分析

目的研究心尖肥厚型心肌病MRI表现和心电图的特点,探讨MRI在心肌肥厚型心肌病中的诊断价值。方法对临床确诊的26例心尖肥厚型心肌病病人MRI表现、心电图资料进行回顾分析。结果 26例病人心脏MRI均提示心尖部心肌肥厚,TAHCM14例,P-AHCM12例,8例T-AHCM舒张期左室表现为典型的"黑桃心"征象。26例病人行心肌首过灌注及延迟强化MRI扫描,11例延迟增强显示心尖部肥厚心肌内不规则增强高信号。26例病人心电图均存在ST-T改变:其中26例左胸导联产生的对称倒置的T波,11例表现为巨大T波倒置(42.3%);16例表现胸前导联R波振幅增高(61.5%);17例出现ST段下移(65.4%);T波倒置深度与心尖部室壁厚度无相关性,但T-AHCM、P-AHCM两组11例延迟强化阳性病例,均表现为巨大T波倒置,两组肥厚心肌的延迟增强阳性率无统计学意义。结论在心尖肥厚型心肌病中,MRI可以准确诊断,延迟强化能够解释心电图中巨大倒置T波原因。     

心尖肥厚型心肌病18例临床分析

目的:对心尖肥厚型心肌病辅助检查进行分析,探讨其临床诊断价值。方法:以心电图、超声心动图、磁共振、冠状动脉造影及左室造影等检查方法检测18例心尖肥厚型心肌病。结果:18例心电图显示胸前导联T波倒置呈TV4>TV5>TV3,R波振幅增高以RV4>RV3> RV5;超声心动图左室心尖室壁舒张期厚度(17.22±14.20mm)与心室间隔基底段厚度(1.07±0.23mm)之比为1.60±0.16;4例冠状动脉造影检查后排除冠心病;6例因超声心动图不典型而行磁共振心脏成像检查后确诊。结论:标准12导联心电图显示胸前导联T波倒置伴R波增高应高度怀疑心尖肥厚型心肌病,可进一步行超声心动图或磁共振检查确诊。     

非冠心病所致深而倒置的T波（综述）

心电图深而倒置的T波,多见于冠心病无Q波心肌梗塞(心内膜下心肌梗塞)、不稳定心绞痛时心肌缺血,也可由非冠心病引起.本文对非冠心病引起深而倒置T波的心电图特点、发生机理及与冠心病T波倒置的鉴别作一简述.一、心尖肥厚性心肌病心失肥厚型心肌病是由日本学者首先报道,以向心性心尖肌肥厚为特征的特殊类型的肥厚型心肌病.其心电图特征为胸前导联巨大倒置的T波(T_V_3-V_6倒置>10mm)伴ST段压低、左室电压升高.有研究观察了肥厚型心肌     

17例肥厚型心肌病病人心电I图特点分析

目的提高对肥厚型心肌病的诊断识别.方法对1996年～2000年确诊为肥厚型心肌病17例病人的临床资料进行分析.结果全部病人心电图均有T波异常,9例心尖肥厚型心肌病病人表现为I、aVL、V2～6导联T波倒置,V1～3导联R波幅度明显增加,其中2例伴完全右束支传导阻滞者亦有左胸导联T波明显倒置;5例普遍肥厚型心肌病病人表现为T波倒置导联较心尖肥厚型心肌病病人范围小(V3～6导联伴或不伴I、aVL导联轻度倒置),V1～3导联R波幅度增加不如心尖肥厚型心肌病病人明显;2例间隔肥厚梗阻型心肌病病人有V1～3导联ST段抬高,T波直立,V1～3导联R波不增加与前两型不同;1例间隔肥厚型心肌病伴完全右束支传导阻滞者表现为V1导联呈qR形态,与心尖肥厚型心肌病伴完全右束支传导阻滞者的rsR'亦不相同.结论重视临床和心电图变化采取进一步的检查措施可以最大限度的减少该病的误诊.     

左心室心尖部室壁增厚特征与心电图T波倒置关系分析

目的:探讨左心室心尖部室壁增厚且心电图胸前导联出现无法解释的广泛T波倒置患者的室壁增厚特征与心电图T波倒置的关系。方法:连续入选91例超声心动图提示左心室心尖部室壁增厚且心电图胸前导联广泛T波倒置的患者,包括53例典型心尖肥厚型心肌病(AHCM)患者(典型AHCM组)、25例早期AHCM患者(早期AHCM组)、13例可疑AHCM患者(可疑AHCM组)。在典型AHCM组与早期AHCM组中共有单纯型29例,混合型49例。测量各导联T波倒置的深度(T)及T波倒置的最大深度(Tmax),测量心尖部各室壁厚度及最大厚度(APWTmax)并计算其与左心室后壁厚度的比值(ABR)。结果:各组间心电图上T波倒置的导联分布、最大深度及胸前导联T波倒置的深度之和比较差异无统计学意义。在78例典型和早期AHCM患者中,心尖厚度与T波深度无明显相关性,但在其中的29例单纯型患者中,APWT max分别与TV_5(r=0.381)及Tmax(r=0.416)弱相关;而在49例混合型及13例可疑AHCM患者中心尖厚度与T波深度也无明显相关。结论:在左心室心尖肥厚程度与T波深度关系上,只有单纯型AHCM患者的APWTmax与T波深度弱相关,而在混合型AHCM患者中二者无明显相关性。     

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.