二尖瓣狭窄并发房颤行球囊成形术前抗凝与不抗凝的比较

目的 :评价二尖瓣狭窄并发房颤患者行经皮二尖瓣球囊成形术 （PBMV）前是否需要常规抗凝治疗。方法 :风湿性心脏病二尖瓣狭窄并发房颤患者 2 5 1例 ,按就诊先后随机分为 A（n=12 6 ） ,B（n=12 5 ）两组。控制心力衰竭后行PBMV。A组术前不使用任何抗凝药物及抗血小板药物 ,B组术前常规给予肝素、肠溶阿斯匹林及华法令抗凝 ,观察PBMV术中及术后 3d有无与 PBMV相关的体循环栓塞并发症。结果 :两组患者 PBMV均获成功 ,术中及术后均无栓塞并发症发生 ,术后血流动力学指标、心功能、二尖瓣口面积、心脏杂音均有明显改善 （P<0 .0 1）。结论 :二尖瓣狭窄并发房颤患者如既往无体循环栓塞史 ,左心房无附壁血栓 ,行 PBMV前并不需苛求常规抗凝。     

小儿心脏瓣膜置换术:抗凝治疗的重新评价

儿童瓣膜置换术后的抗凝剂量不易掌握,常致出血性并发症。作者对一组采用 St.Jude Medical瓣(SJ 瓣)置换左心瓣膜后未作抗凝治疗的患儿进行长期随访,并与成人换瓣后作抗凝治疗组进行对比。重新评价用 SJ 瓣置换术后患儿不用抗凝治疗的安全性。方法:1979～1986年间48例患者应用 SJ 瓣置换左心瓣膜,其中男性25例,女性23例,年龄12±6(0.4～21)岁。术后均未用华法令抗凝。初次手术时,23例置换主动脉瓣,22例置换二尖瓣,3例置换主动脉瓣和二尖瓣双瓣。此外,再次手术换瓣5只,48例共换瓣56只。原发病主要为先天性心脏病和风湿性心脏病。8例(8/22)置换二尖瓣者、15例(15/23)     

风湿性心脏病左心房血栓形成的机制、各因素的作用及其相互关系的研究

目的对风湿性心脏病左心房血栓形成的机制、各因素的作用及其相互关系进行分析。方法选取2012年2月—2014年2月在我院接受治疗的84例风湿性心脏病患者,根据有无血栓将其分为血栓组和无血栓组,每组42例,分别对两组患者左心房面积、二尖瓣膜口面积、抗凝酶Ⅲ(AT-Ⅲ)活性以及左心收缩期内径等情况进行检测,且对比分析两组患者超声心电图结果情况。结果血栓组患者的左心收缩期内径、左心房面积、肺动脉压以及二尖瓣跨瓣压差明显大于无血栓组患者,且血栓组患者的AT-Ⅲ活性明显小于无血栓组,差异有统计学意义(P<0.05)。结论风湿性心脏病并发部分阻塞的左心房血栓形成因素复杂,临床需要加强防范措施,避免风湿性心脏瓣膜病患者左心房血栓的发生。     

风湿性二尖瓣病变并左心房血栓的诊断及外科处理

目的探讨风湿性二尖瓣病变合并左心房血栓的影响因素、诊断及外科治疗。方法回顾分析风湿性二尖瓣病变合并左心房血栓的外科治疗42例,并对影响左心房血栓形成的因素进行分析。术前病变为单纯二尖瓣狭窄5例,二尖瓣狭窄并轻度关闭不全37例。术式为二尖瓣置换36例,二尖瓣成形6例,同时施行三尖瓣成形12例,左心房折叠2例。结果早期死亡2例,分别死于低心排出量综合征和左心室破裂。术后并脑栓塞致右上肢功能障碍1例。随访1~20年,获访36例,心功能恢复良好,超声心动图复查左心房未见血栓。患者术前心房颤动、二尖瓣口裂径<0.8cm或瓣口面积<1.0cm2,左心房内径>50mm,心胸比率>0.6和病程>10年,左心房血栓发生率明显增高。结论二尖瓣口重度狭窄、心房颤动和左心房扩大是左心房血栓易发因素;食道超声可明显提高左心房血栓确诊率;彻底清除血栓,避免脑栓塞,保持左心房内壁相对完整和术后合理抗凝治疗可获得良好疗效。     

重度二尖瓣狭窄合并左心耳血栓患者的球囊扩张术

目的　评价经皮二尖瓣球囊扩张术 (PBMV)治疗重度二尖瓣狭窄合并左心耳血栓的可行性、安全性和有效性。方法　选择经华法令抗凝治疗 12周以上的重度二尖瓣狭窄合并左心耳部位血栓患者 11例 ,男性 2例 ,女性 9例 ,年龄 2 5～ 6 2岁 ,平均 (40 6± 5 7)岁。采用Inoue单球囊技术行PBMV。术后随访 1年以上 ,观察术中及随访期间有无体循环血栓栓塞并发症。结果　手术成功率10 0 % ,术中及随访期间无 1例发生血栓栓塞并发症。术后即刻及随访期间血流动力学及心功能明显改善。结论　对于经适当的华法令抗凝治疗后的重度二尖瓣狭窄合并左心耳血栓的患者 ,PBMV不仅安全可行而且可取得满意的疗效。     

高压氧疗法对风湿性心脏病脑栓塞的治疗作用(摘要)

风湿性心病(风心病)常有左房血栓形成,特别是并发了心房颤动(房颤)者40%有左房血栓,新形成的心房内血栓易于脱落,引起动脉系统栓塞,其中以脑动脉栓塞最多见.风心病置换机械瓣术后需终身抗凝,血栓栓塞发生率每年4%～5%.在发生栓塞后及早进行高压氧等综合治疗,可降低病残率和病死率.截至1996年6月,我们共进行高压氧治疗的风心病脑栓塞55例.其中风湿性心脏瓣膜病、房颤并脑栓塞27例;风心病置换机械瓣术后并脑栓塞28例.     

带栓经皮球囊导管二尖瓣成形术

<正> 风湿性心脏二尖瓣狭窄(MS)患者,常合并心房纤颤(Af).此时左心房血栓发生率高达25%.血栓脱落可造成体循环栓塞,被视为经皮球囊导管二尖瓣成形术(PBMV)的禁忌症.我院从1988年至今行PBMV 503例,对17例MS合并Af,并证实左心房血栓存在的患者抗凝治疗后,带栓进行PBMV 12例,现报告如下:     

风湿性心脏病合并心房颤动经皮球囊二尖瓣成形术远期疗效观察

目的:观察心房颤动患者经皮球囊二尖瓣成形术的远期疗效。方法:318例风湿性心脏病二尖瓣狭窄合并持续性或永久性心房颤动患者,在充分抗凝治疗后,全部采用改良Inoue法行经皮球囊二尖瓣成形术,并进行远期随访。结果:318例心房颤动患者经皮球囊二尖瓣成形术成功296例,成功率为93.1%。失败22例,其中仅1例患者术中发生脑动脉栓塞。经皮球囊二尖瓣成形术术后左心房平均压、左心房内径、二尖瓣口面积、跨瓣压差及肺动脉收缩压较术前差异均有统计学意义(P0.05～0.01)。108例患者经皮球囊二尖瓣成形术后平均随访75±26(12～146)个月,术后远期随访可见二尖瓣口面积仍明显大于术前,跨瓣压差及左心房内径明显小于术前,近期随访结果均与远期随访结果相近似,亦明显小于术前,差异均有统计学意义(P0.05)。结论:二尖瓣狭窄合并持续性或永久性心房颤动患者,经过充分的抗凝治疗后,施行经皮球囊二尖瓣成形术是安全的;且其近期和远期疗效皆佳,值得临床推广。     

心脏介入治疗中动脉栓塞12例溶栓治疗体会

心脏介入治疗中,动脉栓塞是常见的并发症之一。我院自1994年以来,进行各种心脏介入治疗546例,出现动脉栓塞12例,经极早进行动脉局部溶栓治疗,均获得成功。现报道如下。对象与方法1．对象：动脉栓塞患者12例,男性7例,女性5例,年龄47～62岁,脑动脉栓塞2例,股动脉栓塞3例, 动脉栓塞5例,桡动脉栓塞2例。12例栓塞病例中,射频消融术(RFCA)并发4例,为左侧旁道并发的心动过速;经皮二尖瓣球囊扩张术(PB-MV)并发6例,均为重度二尖瓣狭窄;冠状动脉造影并发2例,病人高龄,有高脂血症。12例动脉栓塞病例,11例发生在介入治疗过程中,在导管室内及时溶栓,1例发生于术后2 h,为 动脉栓塞,床旁紧急行局部动脉溶栓治疗。 PBMV动脉栓塞6例,其中房颤5例,窦性心律1例,术前均经食道心脏超声心动图证实左房无附壁血栓。房颤病人PB-MV术前服华法令4～6周进行抗凝治疗。抗凝治疗期间使INR保持在2～3之间。房间隔穿刺成功后,从穿刺鞘管内向左心房推注肝素6 250 U。射频消融及冠状动脉造影,凡穿刺动脉者,均首剂推注肝素6 250 U,以后术程每延迟1h,追加肝素1 250U。     

主动脉夹层合并下肢灌注不良临床治疗分析

目的：探讨主动脉夹层合并下肢灌注不良的治疗经验。方法：南京军区南京总医院2010年1月～2015年5月收治伴有下肢灌注不良的主动脉夹层患者13例,回顾分析其治疗方法及近中期随访结果。结果：所有患者均接受手术,7例B型夹层患者行胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR),其中4例植入裸支架。6例支架释放后造影见原发破口隔绝,真腔扩张,受累髂动脉显影良好。1例术后右下肢缺血坏死行截肢术,后因多器官功能衰竭死亡。6例A型夹层患者,2例术前评估下肢缺血症状明显,急诊行内膜开窗恢复髂动脉血流,二期行杂交手术。其余4例一期行升主动脉、主动脉弓置换 降主动脉覆膜支架植入术,术后造影见下肢动脉恢复真腔供血。术后患者存活12例,下肢缺血症状明显缓解。所有患者均获随访,患者无胸背部剧痛及下肢缺血表现,髂动脉显影良好。结论：主动脉夹层合并下肢灌注不良应尽早干预,主动脉腔内修复术可消除原发破口,恢复真腔血流,改善大部分患者的缺血症状。     

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.     

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.     

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.     

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.