急性肝损伤大鼠血清有机磷酸酯酶活性变化

目的观察实验性急性肝损伤对血清有机磷酸酯酶的影响。方法用１０％Ｄ＿氨基半乳糖盐酸盐１次腹腔注射，诱发Ｗｉｓｔａｒ大鼠急性肝坏死；另施手术结扎胆道诱发ＳＤ大鼠胆汁淤积。采尾血测定血清有机磷酸酯酶（ＰＥ）、磷酸二酯酶Ｉ（ＰＤＥＩ）等。结果大鼠急性肝坏死或胆道结扎早期均可见血清ＡＬＴ、碱性磷酸酶（ＡＬＰ）和ＰＤＥＩ活性增高。血清ＰＥ活性无变化。结论血清ＰＥ活性不受急性肝损伤的影响     

二胺氧化酶在急性坏死性胰腺炎肠道损伤中的作用

目的探讨急性坏死性胰腺炎（ＡＮＰ）时血浆二胺氧化酶（ＤＡＯ）水平变化及其与肠道损伤的关系．方法通过向主胰管内注入牛磺胆酸钠和胰蛋白酶复制犬ＡＮＰ模型（ｎ＝８）;检测血清淀粉酶水平;测定血浆、肠组织ＤＡＯ活性;测量回肠粘膜绒毛形态学改变．结果ＡＮＰ发病后ｄ１（ｍｏｌ／ｓ,００２５±０００６ｖｓ００１１±０００２）,ｄ２（ｍｏｌ／ｓ,００１９±０００５ｖｓ００１２±０００３）血浆ＤＡＯ活性增加,ｄ４（ｍｏｌ／ｓ,０００６±０００１ｖｓ００１４±０００２）以后明显下降,肠组织ＤＡＯ活性亦显著下降;回肠粘膜绒毛萎缩、脱落,高度、宽度降低,面积减少;血清淀粉酶水平升高３～１０倍;肝、胰、脾、肺、肾及肠系膜淋巴结出现细菌移位．结论ＡＮＰ时血中ＤＡＯ活性变化可反映肠粘膜上皮损伤,细菌移位则是肠屏障损伤的结果     

肝硬变腹水患者钾钠氯及酸碱失衡

目的研究肝硬变腹水患者的钾、钠、氯及酸碱失衡。方法肝硬变腹水患者１５４例，血Ｋ＋、Ｎａ＋、Ｃｌ－测定采用ＥＥＬ公司自动分析仪及火焰光度计。血气及酸碱度测定采用ＩＬ１３０２型自动微机分析仪。结果低血钾者５７例，高血钾者６例，低血钠者８１例，高血钠者１２例，低血氯者３４例，高血氯者８例。２４例血气及酸碱度测定结果显示，以碱中毒者为主。依次为呼碱、呼碱＋代酸、代酸、代碱、呼酸。本组高血钾、低血钠与Ｃｈｉｌｄ分级、ＢＵＮ、Ｃｒ值相关。从本组资料表明，重症肝硬变腹水患者水盐代谢失衡多为医源性所致，且加重原有失衡。高钾血症、急性低钠血症及高钠血症大多如此，多为住院后发生，常可危及生命。结论肝硬变腹水患者的高钾血症、低钠血症和高钠血症大多在肝肾功能低下，不适当的治疗所致，是影响预后的重要因素     

Benefits and Limitations of Multimodality Imaging in the Diagnosis of a Primary Cardiac Lymphoma

Primary cardiac tumors are far rarer than tumors metastatic to the heart. Angiosarcoma is the primary cardiac neoplasm most frequently detected; lymphomas constitute only 1% of primary cardiac tumors.We present the case of a 55-year-old woman with a recently diagnosed intracardiac mass who was referred to our institution for consideration of urgent orthotopic heart transplantation. Initial images suggested an angiosarcoma; however, a biopsy specimen of the mass was diagnostic for diffuse large B-cell lymphoma. The patient underwent chemotherapy rather than surgery, and she was asymptomatic 34 months later.We use our patient''s case to discuss the benefits and limitations of multiple imaging methods in the evaluation of cardiac masses. Certain features revealed by computed tomography, cardiac magnetic resonance, and positron emission tomography can suggest a diagnosis of angiosarcoma rather than lymphoma. Cardiac magnetic resonance and positron emission tomography enable reliable distinction between benign and malignant tumors; however, the characteristics of different malignant tumors can overlap. Despite the great usefulness of multiple imaging methods for timely diagnosis, defining the extent of spread and the hemodynamic impact, and monitoring responses to treatment, we think that biopsy analysis is still warranted in order to obtain a correct histologic diagnosis in cases of suspected malignant cardiac tumors.     

复方中药体外保护肝细胞的机制

目的探讨复方中药制剂体外保护肝细胞的机制.方法用MTT法、荧光染色、透射电镜、DNA琼脂糖凝胶电泳及流式细胞术等方法观察不同浓度中药复方制剂(包括黄芩、黄柏、板蓝根、山豆根等)抑制TNF-α+Act-D诱导正常大鼠肝细胞凋亡的作用,并检测各组清蛋白的分泌结果自组中药复方制剂能明显改善肝细胞的凋亡状况,出现了典型的形态学和生化学改变,但存在药物浓度上的差异.中药组(0.2,2 mg.L-1)的凋亡率(10.4%±1.2%,13.9±0.4%)低于凋亡模型组(vs17.4%±1.9%,n=3,P＜0.05),中药组(20mg.L-1)的凋亡率(18.30%±1.15%)与凋亡模型组相比没有显著性差异(P＞0.05).除此之外,自组中药复方制剂还促进肝细胞清蛋白的分泌,但存在作用时间和药物浓度的交互作用.结论复方中药制剂能够抑制正常肝细胞凋亡并促进其清蛋白分泌.     

Exercise-Induced Syncope in a Sedentary Woman

Vasovagal (neurocardiogenic) syncope, a subtype of reflex syncope, has many well-known triggers. However, we found no previous report of vasovagal exercise-induced syncope in a sedentary person. We present the case of a 35-year-old sedentary woman who experienced vasovagal syncope as she underwent an exercise stress test. Results of evaluations, including resting and stress electrocardiography and echocardiography, were normal. Her presentation is highly unusual: syncope has typically not been associated with exercise except in young athletes, people with structural heart abnormalities, or people with a prolonged QT syndrome. To our knowledge, this is the first report of vasovagal syncope associated with exercise in a sedentary patient who had normal cardiac and electrophysiologic function. We suggest possible physiologic mechanisms and diagnostic strategies.     

High prevalence of ectopic kidney in Coast Province, Kenya

OBJECTIVE: To establish the prevalence of congenital urinary tract abnormalities in a full population-based ultrasound survey of an area of coastal Kenya. METHODS: Ultrasound examination of 3118 residents of 912 households, including all available subjects over 2 years of age, residing in five contiguous rural villages 50 km south of Mombasa. RESULTS: Survey findings indicated simple renal ectopia in 11 of 3118 subjects (0.35%) and renal agenesis in three (0.096%). No cases of horseshoe kidney or complex urinary anomaly were detected, and no cases of multiple congenital anomaly were found. Ectopia cases were evenly distributed between men and women, and across the five study villages. None of the individuals affected by renal ectopia were closely related (i.e. <5th-degree relations). CONCLUSION: There is an unusually high prevalence of ectopia among unrelated subjects in this area. In this setting, the findings suggest either a common exposure to teratogenetic factors, or a hereditary condition with variable penetrance, where more severely affected individuals are not observed because of foetal/infant mortality.     

COL_I在老年人大肠粘膜表达的临床意义

目的研究ＣＯＬＩ单克隆抗体在老年人大肠粘膜活检中对粘膜上皮增生，不典型增生、癌变中鉴别诊断的意义．方法对１９８５年～１９９５年无症状查体的老年人５６例大肠镜检查中发现的隆起性病变活检标本７７块，应用免疫组织化学方法，检测ＣＯＬＩ单克隆抗体在组织中的表达分析各种大肠粘膜病变（正常２７块，炎症９块，增生性息肉１１块，腺瘤２２块及腺癌８块）的表达情况，对结果进行讨论．结果ＣＯＬＩ表达阴性者３３／７７块，其中３１块为无增生上皮（９４０％）。表达阳性者２５块，其中１２块（４８０％）为腺瘤或腺癌；表达＋＋者１３块，其中有１２块为不典型增生上皮（９２０％），表达＋＋＋者６块，均为大肠腺癌（１００％）．结论ＣＯＬＩ是大肠粘膜鉴别增生、不典型增生，癌变的很有实用价值的单克隆抗体．     

Copper transportion of WD protein in hepatocytes from Wilson disease patients in vitro

AIM:To study the effect of copper transporting P-typeATPase in copper metabolism of hepstocyte andpathogenesis of Wilson disease(WD).METHODS:WD copper transporting properties in someorganelles of the cultured hepstocytes were studied fromWD patients and normal controls.These culturedhepstocytes were incubated in the media of copper 15mg·L~(-1) only,copper 15 mg·L~(-1) with vincristine(agonist of P-type ATPase)0.5mg·L~(-1),or copper 15 mg·L~(-1) withvanadate(antagonist of P-type ATPase)18 39mg.L~(-1)separately.Mlcrosome(endoplasmic reticulum and Golgiapparatus),lysosome,mitochondria,and cytosol wereisolated by differential centrifugstion.Copper contents inthese organelles were measured with atomic absorptionspectrophotometer,and the influence in copper transportionof these organelles by vanadate and vincristine werecomparatively analyzed between WD patients and controls.WD copper transporting P-type ATPase was detected bySDS-PAGE in conjunction with Western blot in liver samplesof WD patients and controls.RESULTS:The specific WD proteins(Mr155 000 lanes)wereexpressed in human hepatocytes,including the control andWD patients.After incubation with medium containingcopper for 2 h or 24 h,the microsome copper concentrationIn WD patients was obviously lower than that of controls,and the addtion of vanadste or vincristine would change thecopper transporting of microsomes obviously.Whenincubated with vincristine,levels of copper in microsomewere significantly increased,while incubated with vanadate,the copper corcentrations in microsome were obviouslydecreased.The results indicated that there were WDproteins,the copper tmnsportion P-type ATPase in themicrosome of hepstocytes.WD patients possessedabnormal copper transporting function of WD protein in themicrosome,and the agonist might correct the defect of copper transportion by promoting the activity of coppertransportion P-type ATPase.CONCLUSION:Copper tmnsportion P-type ATPase plays animportant role in hepatocytic copper metabolism.Dysfunction of hepatocytic WD protein copper transportionmight be one of the most important factors for WD.     

Bacterial Pancarditis with Myocardial Abscess: Successful Surgical Intervention in a 14-Month-Old Boy

A 14-month-old boy with a structurally normal heart presented with signs of cardiac tamponade caused by purulent pericarditis. During his hospital stay, mitral and tricuspid valve endocarditis developed, and a ventricular septal abscess expanded despite appropriate, prolonged antibiotic therapy for methicillin-resistant Staphylococcus aureus. The day before scheduled surgical correction, the abscess ruptured, creating a septal aneurysm. Surgical intervention resulted in an excellent outcome. Throughout the patient''s 67-day hospitalization, the use of echocardiography was crucial in monitoring and diagnosis.In addition to reporting this case, we discuss our diagnostic and treatment considerations. To our knowledge, this is only the 4th report of S. aureus bacterial pancarditis with myocardial abscess.     

胃病患者血浆内皮素水平的变化

目的研究消化性溃疡、慢性胃炎（急性活动期）、胃癌患者血浆内皮素－１水平的变化意义．方法采用放射免疫分析法测定了胃溃疡１４例，十二指肠溃疡９例治疗前后及胃炎１５例（急性活动期），胃癌１５例空腹血浆内皮素－１水平，并与１６例健康人作对照．结果胃溃疡（６２９６±２００１ｎｇ／Ｌ），十二指肠溃疡（４５５８±１６５７ｎｇ／Ｌ），慢性胃炎（４５７６±１８７４ｎｇ／Ｌ）及胃癌（４９８２±１３６８ｎｇ／Ｌ）患者血浆内皮素－１水平较对照组（２９７０±９２７ｎｇ／Ｌ）显著升高（Ｐ＜００１）．胃溃疡组（活动期）血浆内皮素＿１水平又明显高于十二指肠溃疡（活动期）胃炎组（Ｐ＜００５）．治疗后胃溃疡组血浆内皮素＿１水平显著下降（Ｐ＜００５）．结论血浆内皮素＿１可能参于胃病的病理生理过程     

Ochronotic Involvement of the Aortic and Mitral Valves in a 72-Year-Old Man

Ochronosis, an autosomal recessive metabolic disorder, causes an excess of homogentisic acid that results in adverse pigmentation, calcification, and inflammation of cartilaginous and other tissues. Cardiovascular abnormalities are less frequently reported than are other manifestations. In rare cases, ochronosis can cause valvular heart disease. We report the case of a 72-year-old man with aortic stenosis and mitral insufficiency who was diagnosed with ochronosis while undergoing surgical aortic and mitral valve replacement. We discuss the history and surgical management of alkaptonuric ochronosis.     

Cardiac syncope in pediatric patients

OBJECTIVE: To assess the epidemiology of cardiac syncope in children and evaluate the guidelines on its management. MATERIAL AND METHODS: We analyzed the etiology to syncope and diagnostic workup in consecutive pediatric patients presenting with syncope in our emergency departments or cardiac outpatient clinics between 1997 and 2005, and who were subsequently diagnosed as having cardiac syncope. RESULTS: A primary cardiac cause was identified in 11 syncopal patients presenting to the emergency room and 14 patients to the cardiac clinic: supraventricular tachyarrhythmia in 9, ventricular tachyarrhythmia in 10, pacemaker dysfunction in 2, and isolated cases of sick sinus syndrome, hypoxic spell, hypertrophic cardiomyopathy, and primary pulmonary hypertension. Some elements suggested potential cardiac disease as a cause of syncope in all cases. The resting electrocardiogram and the echocardiogram were interpreted as positive and relevant to the diagnosis in 17 and 3 patients, respectively. Exercise electrocardiogram and Holter recording provided diagnostic information previously not seen on the resting electrocardiogram in six and three patients, respectively. Three children have died and one child has neurological sequelae following resuscitation. CONCLUSION: Our data support the premise that careful history taking with special focus on the events leading up to syncope, as well as a complete physical examination, can guide practitioners in discerning which syncopal children need further cardiac investigations.     

吞咽障碍患者咽和食管的动态造影

目的探讨在吞咽障碍患者中咽和食管动态造影（ＰＥＤＩ）的方法和价值．方法对吞咽障碍患者共进行ＰＥＤＩ８５１例次．ＰＥＤＩ程序：直立咽部侧、斜、正位吞钡Ｘ线录像和食管仰卧吞钡右前斜位Ｘ线录像或点片．结果发现功能或动力性疾病６０４例（７１％）,发生于咽、食管及咽连同食管３者的频率分别为１６２例（１９％）,２４７例（２９％）和２７２例（３２％）．结构性病变６８例（８％）,发生于咽和食管者分别为１１例（１３％）和５７例（６７％）,结构性病变中功能异常者６６例（７８％）,占６８例中的９８％．无异常发现者１２２例（１４３％）．结论ＰＥＤＩ是诊断吞障的方便、准确的检查方法,与测压结果的符合率可达９８％．     

Acute Coronary Thrombosis and Multiple Coronary Aneurysms in a 22-Year-Old Man with the Human Immunodeficiency Virus

The human immunodeficiency virus (HIV) can cause diverse cardiovascular complications. In HIV patients on antiretroviral therapy, the prevalence of myocardial infarction has steadily increased over the years. Young patients who are naïve to antiretroviral therapy and who experience coronary events are not well represented in the medical literature. We describe the case of a 22-year-old man, infected with HIV for 4 years and never treated with antiretroviral therapy, who emergently presented with a non-ST-segment-elevation myocardial infarction. Coronary angiograms revealed thrombosis and multiple coronary artery aneurysms; however, no areas of atherosclerotic stenosis were apparent. He was successfully treated with coronary stenting, antiplatelet therapy, and anticoagulation. Nine months after the initial presentation, he exhibited excellent exercise capacity, and no ischemia was evident. We discuss the various therapeutic approaches in this case.     

扩张型心肌病发病机制的研究进展

扩张型心肌病（DCM）以左心室或双心室扩张并伴收缩功能受损为特征，其发病机制主要与病毒感染后的自身免疫反应有关。80年代以后，遗传因素与DCM的关系逐渐受到重视，分子生物学技术的发展促进了这方面的研究。本文就DCM的免疫学和遗传学两方面的研究进展作一简要综述。