新利尿合剂及硝普钠联合治疗老年人充血性心力衰竭伴顽固性水肿的疗效观察

伴有顽固性水肿的充血性心力衰竭（CHF）是各种心脏病患者心衰发展至终末期的严重的临床表现。老年患者具有症状重、预后差、病死率较高的特点。其治疗主要是严格控制入水量或短期应用糖皮质激素。静脉输注高渗盐水。或对患者进行血液透析或血液滤过。我们在常规抗心力衰竭治疗的基础上，在同时静脉应用硝普钠的前提下，静脉输注由右旋糖酐40、多巴胺、速尿组成的新利尿合剂来治疗老年人CHF伴顽固性水肿，取得较好的疗效。     

老年顽固性心力衰竭患者短期血液透析治疗的临床评价

<正> 顽固性心力衰竭是临床常见而又难治的心脏疾病,其病死率一直居高不下,虽然国内外许多学者采取了许多综合性治疗措施,然而纽约心功能分级标准(NYHA)Ⅲ-Ⅳ级的患者预后仍差,活动耐力受限。近几年来,国内外已有学者采用血滤或血液透析的方法矫治顽固性心力衰竭取得了一些进展,由于研究结果差异较大,已成为当今研究的焦点。本研究从临床、血生化及神经内分泌改变方面对其进行了系统的研究,探讨其临床意义。     

巯甲丙脯酸对老年顽固性充血性心衰的长期疗效观察

本文用巯甲丙脯酸（CPT）维持治疗老年顽固性充血性心衰（CHF）30例。结果显示:治疗4周,显效11例,有效15例,总有效率86.7％;治疗8周,则分别为15％、13％、93.3％;维持治疗6个月,有效的病例均无心功能恶化。CPT使血钾轻度升高,不影响血糖,具有降胆固醇和甘油三酯的作用,是维持治疗老年顽固性CHF较为理想的药物。     

无创正压通气治疗慢性充血性心力衰竭机理探讨

慢性充血性心力衰竭(CHF)是一种复杂的临床症候群,是各种心脏疾病的严重阶段;具有高患病率,高死亡率,人们不断地寻求防治CHF的有效方法。随着临床实践的不断深入,从单纯以改善血流动力学到拮抗神经-内分泌激素治疗,有效地减慢CHF的进程,提高了生存率。近年来,国内外学者开辟了非药物治疗CHF的试验和临床研究。从呼吸和循环系统相互作用,相互影响概念出发,使用无创正压通气(NPPV)作为CHF的辅助治疗方法,其治疗作用及地位越来越受到重视,并在临床中逐步得到推广。目前多采用双水平气道正压通气(BiPAP)模式。Acosta等[1]使用BiPAP…     

非糖尿病心力衰竭患者胰岛素抵抗普遍存在且与活动耐量下降相关

已有一些证据提示慢性心力衰竭（CHF）是一种胰岛素抵抗（IR）状态,但CHF患者IR的患病率及其与CHF的关系还仍未完全明确。Matlooba A. ALZadjali等学者进行了相关研究。     

慢性心力衰竭患者窦性心律震荡现象

慢性心力衰竭(CHF)是临床常见的心血管疾病之一,其发病率较高,同时也足发牛心脏性猝死的高发人群,对其危险度分层和预后判断有着重要的临床意义,近年来,有学者提出窦性心律震荡现象(hean rate turbulence,HRT),被认为是一项心肌梗死后猝死高危患者可靠的预测办法.笔者通过观察这一指标在40例CHF患者中的变化规律,以评价其在CHF患者中的预测价值.     

治疗剂量的Dobutamine对心衰患者血清镁的影响

Dobutaminc(Do)为β受体兴奋剂(显著β_1受体刺激作用,轻度β_2受体作用)系经静脉非洋地黄类正性肌力药物。我们间断用其治疗严重慢性顽固性充血性心力衰竭(CHF),因洋地黄中毒、Ⅲ度房室传导阻滞等不同禁忌证而不能应用洋地黄类药物及其它药物不能控制的慢性CHF取得满意效果.有人报告β受体拟似剂使血清钾下降而增加发生室性心律失常(VR)的危险,尚没见有对血清镁影响的报告。本研究旨在观察Do对CHF者血清镁的影响及与VR的关系。     

充血性心力衰竭患者血清IL-1β变化及胺碘酮对PBMC分泌IL-1β的影响

近年来,细胞因子参与心肌细胞收缩功能的调节及其在充血性心力衰竭(CHF)发生发展中的作用已受到国内外学者的关注,但其确切机制尚不明确。胺碘酮等抗心律失常药物对CHF的有益作用已见报道,但其作用机制亦不清楚。本研究测定CHF患者的血清IL-1β水平,并观察胺碘酮对CHF患者外周血单个核细胞(PBMC)分泌IL-1β的影响,以探讨IL-1β在CHF发生发展中的作用及胺碘酮对CHF的作用机制。1　资料与方法1.1　临床资料　观察组为CHF患者20例,根据纽约心脏病学会(NYHA)心功能分级标准,分为心功能级10例,男7例、女3例,年龄61.2±6.1(48～69)…     

米力农治疗顽固性充血性心力衰竭的疗效分析

目的观察米力农治疗顽固性充血性心力衰竭(CHF)的临床疗效。方法选择2009年6月—2013年5月在我院住院的顽固性CHF患者96例,根据治疗方法将所有患者分为试验组48例和对照组48例。两组患者均进行常规治疗,对照组加用多巴酚丁胺,试验组加用米力农。观察两组患者治疗前后N末端脑钠肽前体(NT-proBNP)、左室射血分数(LVEF)、短轴缩短率(FS)、心脏每搏输出量(SV)及心输出量(CO)。结果治疗前两组患者NT-proBNP、LVEF、FS、SV、CO比较,差异均无统计学意义(P0.05);治疗后试验组患者NT-proBNP低于对照组,LVEF、FS、SV、CO高于对照组(P0.05)。与治疗前比较,对照组和试验组NT-proBNP均降低,LVEF、CO均升高,试验组FS、SV均升高(P0.05)。结论米力农治疗顽固性CHF安全有效,值得在基层医院推广。     

缬沙坦对充血性心力衰竭患者血浆内皮素和心房钠尿肽水平的影响

充血性心力衰竭(CHF)患者体内交感神经系统及肾素-血管紧张素-醛固酮(RAS)等系统功能亢进,内皮素(ET-1)和心房钠尿肽(ANP)等血管收缩性因子分泌增多,可使心功能不全进一步恶化[1]。给予CHF患者应用血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体拮抗剂(ARB)可以阻断肾素-血管紧张素-醛固酮等系统[2,3],但有些患者因ACEI的副作用(如血管性水肿和顽固性咳嗽)而无法耐受。ARB与ACEI相比较,作用相当而副作用较少,因此用于治疗CHF有其相应优势。目前关于ARB对CHF患者血浆ET-1和ANP影响的研究较少,因此,本研究观察ARB类缬沙…     

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.