预激综合征对QRS波终末向量的影响

为探讨预激综合征对QRS波终末向量的影响和终末向量改变的临床意义 ,选择经射频消融 (RFCA)术治愈的显性预激综合征患者 12 9例 ,据旁道部位分 9组 :左前壁 (LA)、左侧壁 (LL)、左后壁 (LP)、右前壁 (RA)、右侧壁(RL)、右后壁 (RP)、右前间隔 (RAS)、右中间隔 (RMS)、右后间隔 (RPS) ,对比分析RFCA术前、后心电图。结果 :①与消融旁道后心电图对比 ,12 9例显性预激综合征均影响终末向量。②终末向量改变与旁道位置有关 :aVL(和Ⅰ )导联 :终末负向波振幅增加 ,或终末正向波变为负向波主要出现在LA、LL旁道 ;终末正向波振幅增加 ,或负向波振幅减小或变为正向波主要出现在LP、RA、RL、RP、RAS、RMS、RPS旁道。Ⅲ (和aVF)导联 :终末正向波振幅增加 ,或负向波变为正向波 ,或终末无变化主要出现在LA、LL、RA、RAS旁道 ;终末正向波变为负向波 ,或正向波振幅减小 ,或负向波振幅增加主要出现在LP、RL、RP、RMS、RPS旁道。V1导联 :终末负向波振幅减小或消失主要出现在LA、LL、LP旁道 ;终末负向波振幅增加主要出现在RA、RL、RP、RAS、RMS、RPS旁道。③终末向量改变与预激波有关 :aVL、Ⅰ、Ⅱ、aVF、Ⅲ、V1导联QRS波终末向量的变化与预激向量方向基本一致 (P <0 .0 1)。结论 :观察终末向量的改变可能有助于delta波不     

S预激综合征对心室除极终末向量的影响

目的 对87例显性房室旁路及26例隐匿性房室旁路患者导管射频消融术前后体表心电图QRS波终末40ms的向量变化进行分析，探讨预激综合征对心室除极终末向量的影响。方法 选择经射频消融术证实的显性单房室旁路87例及隐匿性单房室旁路26例患者，经临床常规检查无器质性心脏病。将房室旁路分为间隔、左后游离壁、左前游离壁、右后游离壁及右前游离壁房室旁路。结果87例显性房室旁路中的72例患者导管射频消融术后终末向量发生改变，15例无变化，26例隐匿房室旁路中的2例患者导管射频消融术后终末向量发生改变，24倒无变化，显性房室旁路与隐匿房室旁路相比差异有显著性(P<0．05)，不同部位间的显性房室旁路相比差异无显著性(P>0．05)，显性房室旁路终末向量的变化特点具有导联的特异性，后间隔房室旁路主要表现Ⅱ、Ⅲ、aVF导联S波变浅或消失及V2～V4导联原有S波加深或新出现S波，中间隔房室旁路表现V2～V4导联原有S波加深或新出现S波，前间隔房室旁路表现Ⅰ、aVI，导联新出现S波及V4导联原有S渡加深，左后游离壁房室旁路表现Ⅰ、aVL导联新出现S波及V1～V4导联原有S波加深或新出现S波，左前游离壁房室旁路表现Ⅰ、Ⅱ．aVF导联波变浅或消失及V1～V4导联原有S波加深或新出现S波，右后游离壁房室旁路表现V2～V4导联原有S波加深或新出现S波，右前游离壁房室旁路表现口Ⅱ、Ⅲ、aVF导联S波加深及V4导联S波加探或新出现S波。结论任何部位显性房室旁路均可引起QRS波终末向量的改变，这种改变有导联的特异性。提示预激综合征不但影响QRS起始向量的改变，也可导致QRS终末向量的改变。     

射频消融显性房室旁道对心电图额面电轴和横面移行区的影响

目的探讨射频消融(RFCA)显性房室旁道对心电图额面电轴和横面移行区的影响。方法选择经RF-CA术证实的显性单房室旁道86例及隐匿性单房室旁道30例患者为研究对象。将房室旁道分为左前壁(LA)、左后壁(LP)、左侧壁(LL)、右前侧壁(RAL)、右后侧壁(RPL)、右侧壁(RL)、前间隔(AS)、中间隔(MS)及后间隔(PS)房室旁道。对比分析RFCA术前、后心电图。观察RFCA术前、后额面电轴的改变或/和横面移行区的移位。结果①30例隐匿性房室旁道患者RFCA后,心电图额面电轴无一例发生变化,横面移行区2例发生变化,28例无变化。②86例显性房室旁道患者RFCA术后,心电图额面电轴和/或横面移行区均发生改变。LL、LA旁道心电轴右移(P0.01);LP、RL、RPL、MS及PS旁道心电轴左移;RAL、AS旁道术前、术后心电轴无差异(P0.05)。结论显性房室旁道可引起心电图额面电轴和横面移行区的变化,且改变特点与旁道部位有关。     

显性预激射频消融术后T波记忆现象的临床意义

目的探讨显性预激综合征患者射频消融术后出现T波记忆现象的临床特征及意义。方法选择持续性显性预激综合征经射频消融手术后出现T波倒置的64例患者,通过观察心电图T波变化的深度来分析总结T波记忆现象的特征和发生规律。结果右后壁、右后间隔及右侧壁、右后侧壁显性旁道消融术后,T波记忆现象多出现在Ⅲ、aVF、Ⅱ导联,且T波在三导联中倒置深度差异有统计学意义（P〈0.05～0.01）;左后壁、左后侧壁及左后间隔显性旁道消融术后,T波记忆现象也多出现在Ⅲ、aVF导联,T波倒置深度差异无统计学意义（P〉0.05）。前壁或前侧壁旁道消融后T波记忆多出现在aVL、Ⅰ导联,两导联中T波倒置深度差异有统计学意义（P〈0.05）。T波记忆的出现具有规律性,在1～30d内能自行恢复。结论 T波记忆是显性预激综合征患者射频消融术后常见的一种心电现象,不具病理意义。     

后间隔房室旁路体表心电图的定位诊断

目的 探讨预激综合征在左、右及后间隔旁路的位置与体表心电图特征性改变的相关关系。方法 以80例预激综合征射频消融前后作对照,寻找体表心电图的特征性改变与左、右及后间隔旁路位置关系,确定体表心电图定位左、右及后间隔旁路的鉴别诊断标准,并计算其鉴别诊断的敏感性、特异性和准确率。结果 体表心电图的8大特征变化与预激左右后间隔旁路定位鉴别诊断有关,即V1导联QRS波形态、Δ波方向;Δ波及QRS波的额面电轴及二者差值;Ⅲ导联R／S波比值;胸前导联R／S＞1的转折点;PV1-PE间距。根据以上8大特点对术前80例预激重新定位,其鉴别诊断敏感性、特异度及准确率在右后间隔旁路分别是88．2％、83．3％和77．5％,而左后间隔是83．3％、88．2％、87．5％。结论 B型预激旁路绝大部分位于右后间隔旁路,但也不排除左后间隔旁路,尤其是左后旁路预激不安全时可出现B型预激改变,上述体表心电图的8大特征有助于二者鉴别诊断。     

QRS_(V1)呈rSr′型在预激综合征中的诊断意义

预激综合征的诊断和旁路定位主要依据初始向量 (δ波 ) ,近年来 ,预激综合征对终末向量的影响已引起关注[1- 5] ,但终末向量变化在预激综合征诊断中的意义尚少见报道。本文通过对比分析显性预激综合征RFCA术前、术后心电图 ,观察术前QRSV1呈rSr′型在预激综合征中的诊断意义。1　资料与方法1.1.　临床资料　选择 1997年 1月— 2 0 0 4年 1月经RFCA成功根治、临床排除器质性心脏病、电生理资料完整的显性单旁路预激综合征患者 12 9例。年龄 6～ 74岁 ,平均 (38.4 7± 15 .30 )岁 ,其中男 81例 ,女 4 8例。旁路部位 :左前壁 (LA ,距冠状…     

右位心合并预激综合征的心电向量分析

患者女53岁。临床诊断:冠心病、右位心。心电图示:R-R间期为0.10s、肢导QRS波Ⅰ、Ⅱ、Ⅲ、aVF均呈QS波型,起始有“△”波,QRS时限>0.12s胸导V_1呈Rs型,V_(3、4、5)呈QS波,左右手反接加做V_3R-V_5R呈R波,电压明显增高,并有多导联ST-T改变。心电图诊断:窦性心律,右位心合并预激综合征。下壁心肌梗塞,右室肥大待排。为了明确诊断、做心电向量检查。心电向量特征:各面QRS环起始部运     

间歇性预激综合征突显QRS终末波的极性改变及机制

目的 明确是否各处预激都有QRS终末波极性改变.方法 收集各种比例(2:1～4:3)的间歇性预激综合征共11例.按射频导管消融成功的靶点定位,分析QRS终末波的极性.结果 预激使QRS终末波极性逆转10例.至少2个导联逆转的有8例,最多1例达5个导联.前8例涵盖了左心室前壁和侧壁,右心室前壁、侧壁、后壁、前间隔和后间隔.结论 心室去极化过程中,预激始终存在是引起预激综合征QRS终末波极性改变的原因.这种改变并不局限于少数区域.     

食管心房调搏诊断不完全性潜在性预激综合征1例

不完全性潜在性预激综合征为预激综合征的一种少见类型,表现为P-R间期正常、无δ波,而终末向量和波形改变(对照心动过速)成为旁路预激心室的主要表现。本例为下壁导联出现异常Q波,酷似心肌梗死患者,通过食管心房调搏检查诱现预激波、诱发心动过速,从而明确了不完全性潜在性预激综合征的诊断,且射频消融后QRS波群终末部分与心动过速时一致,进一步证实了该诊断。     

预激综合征对QRS中间及终末向量的影响

预激综合征(WPW)无创心电图的诊断和旁路定位主要依据QRS波群初始向量,即预激波的分析.近年研究发现,WPW不但可以引起QRS波群初始向量的改变,还可以引起QRS波群中间向量和终末向量的改变.     

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.