Normal Electrophysiological Findings in a Patient with Symptomatic Intermittent Advanced Atrioventricular Block

This report describes an otherwise healthy young woman who presented with syncope during episodes of advanced atriovenlricular (A V) block. The His bundle recordings during normal sinus rhythm and atrial and ventricular pacing were normal. Carotid sinus massage produced no abnormality. Subsequently, (he patient received a permanent pacemaker and has been free of symptoms. In termittent advanced A V block has been observed on follow-up electrocardiograms. This unique case demonstrates a potential limitation of routine electrophysiologic investigation.     

The Role of Imagery in the Treatment of a Patient with Malignant Melanoma

Feelings of hopelessness and apathy in critically ill patients can present significant obstacles to rational, logical solutions. Forms of psychotherapy which are entirely verbal are often limited in their effectiveness to resolve such existential crisis. Other modes of therapy which employ imagery may be more effective. The patient’s own imagery appears to have particular value as a vehicle for resolving impossible dilemmas which are experienced by patients facing imminent death.     

冠脉造影正常的老年急性心肌梗死

5例老年急性心肌梗死患者,平均年龄68岁,有心绞痛史5例,高血压史4例,糖尿病史3例,高脂血症4例,吸烟史2例.心电图诊断:前壁心梗2例,前间壁心梗2例,下壁伴右室面心梗1例,Q波心梗4例,非Q波心梗1例.心脏彩超,梗死2周内室壁运动异常3例,随诊后3例均恢复正常.5例病人行冠脉造影及左心室造影结果,5例冠脉造影正常,3例左室室壁运动异常.结论:老年急性心肌梗死造影正常的原因很可能是冠脉造影局限性出现的假阴性所致.     

Coronary Artery Calcium Scoring: a Valuable Aid in Shared Decision Making Among Non-traditional Risk Markers

Purpose of the Review

The purpose of this study was to evaluate the utility of coronary artery calcium (CAC) scoring and compare it with other non-traditional cardiovascular risk markers for improvement in cardiovascular risk assessment.

Recent Findings

CAC scoring refines risk assessment among asymptomatic patients eligible for primary prevention across the spectrum of cardiovascular risk. Its use has been well-validated in several multi-ethnic population-based cohorts. With the recent ACC/AHA cholesterol treatment guidelines expanding the eligibility for statin therapy for primary prevention, the absence of CAC can be a powerful tool for identifying those at lower risk of future cardiovascular events. CAC is superior to other non-traditional risk markers recognized by the current risk assessment guidelines for re-classifying patients to appropriate risk categories and improving discrimination of risk beyond traditional risk factors.

Summary

CAC scoring is a reliable decision-making tool for improving cardiovascular risk assessment and performs better than other non-traditional risk markers, particularly when used to identify those at lower risk (i.e., CAC = 0).

     

Role Considerations in Care of the Dying Patient

Twentieth century Americans are ill-prepared for death, either their own or that of another. Death has become a less visible part of daily life. Health professionals in general and nurses in particular often deny their legitimate role in relation to the dying patient, and instead regard death as a treatment failure. This paper contrasts the dying role and the sick role of the patient, and the therapeutic role and the supportive role of the nurse. It applies the concepts of role insufficiency and role supplementation to the care of the dying and suggests implications for research.     

Quantitative Radioautography of Sugar Transport in Intestinal Biopsies from Normal Humans and a Patient with Glucose-Galactose Malabsorption

Both galactose accumulation and phlorizin binding by columnar epithelial cells have been investigated in vitro with a recently developed technique for high-resolution, plastic-section radioautography which is particularly suited to small quantities of biopsy tissue. Grain density analysis of the radioautographs provides definitive support for the view that the cellular mechanisms underlying glucose-galactose absorption in laboratory animals are fully applicable to the small intestine of man. Even the number of sugar carriers at the microvillar membrane appears similar and the major quantitative difference, lower affinity for phlorizin in man, correlates with the finding that phlorizin is also a less potent inhibitor of uphill, galactose transport at the microvilli. In addition, radioautographs of biopsies taken 2 yr apart from a patient with glucose-galactose malabsorption provide evidence that the cellular defect in this inborn error of transport is a persistent reduction in the number of functioning sugar carriers at the microvillar membrane.     

The Role of Calcium in Insulin Action

Abstract. The in-vitro antilipolytic response to insulin and procaine hydrochloride by adipose tissue from young rats (150–180 g) and lean mice has been compared with that from aged Wistar rats (600 g) and obese (ob/ob) hyperglycaemic mice. 1. The adipose tissue from the obese mice showed diminished responsiveness to insulin and to procaine hydrochloride. Response to these agents, however, was restored by prewashing the tissue, suggesting that the apparent resistance in this tissue reflected saturation of the insulin receptors to endogenous insulin. 2. In adipose tissue of old Wistar rats the antilipolytic effect of insulin was also impaired, but this was not restored after extensive washing. Unlike adipose tissue ghosts prepared from young rats, insulin did not decrease the binding of calcium to ghost membrane preparations from old rats. Neither did insulin inhibit the adrenaline stimulated calcium efflux from perifused isolated fat cells prepared from old rats. These results suggest that the insulin response of fat cells from old rats is impaired because of a defect either in their insulin receptors or in their post-receptor responses. 3. Procaine-hydrochloride, however, when added to the medium perifusing fat cells of these old rats inhibited the adrenaline stimulated lipolysis, reduced the Ca efflux and decreased the binding of Ca to fat cell ghosts; as it did with similar preparations of young rats. Thus the cells from old rats still show full post-receptor responsiveness to an insulin-like stimulus, provided the stimulus for such a response is given at a point beyond the insulin receptor itself. The results suggest that the insulin resistance observed in old rat fat cells may be related to some by deficiency in the insulin receptors, possibly due to their lower replacement with age.     

Reappearance of Persistent Normal Sinus Rhythm in a Patient with the Sick Sinus Syndrome Following Cardiac Pacing for 10.5 Years

A patient with symptomatic sick sinus syndrome which manifested as a brady-tachy syndrome, was admitted to our institute in 1969. Following cardiac pacing for 10.5 years, the brady-tachy syndrome disappeared and normal sinus rhythm was restored. Her stable normal sinus rate has persisted up to the present, 2.5 years after termination of pacing.     

Calcium — a Neglected Key Factor in Arteriosclerosis. The Pathogenetic Role of Arterial Calcium Overload and Its Prevention by Calcium Antagonists

Using specific calcium antagonists as experimental tools, both the physiological messenger and current carrying functions of calcium ions as well as their pathogenetic potencies could be elucidated. Notably, excess intracellular calcium signalling and intra-and extracellular calcium overload turned out to be pathogenetic principles of general importance. In this context, progressive calcium overload of arteriosclerotic vascular walls and the antiarteriosclerotic effects of calcium antagonists, deserve particular interest. In fact, with the help of calcium antagonists, arterial calcium overload as decisive component of various types of experimental arteriosclerosis became accessible to a direct therapeutic intervention. According to their responsiveness to calcium antagonists, two pathophysiologically different types of experimental coronary plaques could be characterized: (1) The calcium type, i.e. coronary calcinosis of vitamin D₃-intoxicated rats highly sensitive to calcium antagonist treatment, (2) the cholesterol type, represented by coronary atheromata of cholesterol-intoxicated rabbits; this primary coronary cholesterol accumulation could not be inhibited by calcium antagonists. The formation of conventional human coronary artery plaques is characterized from the very early lesion onwards by a progressive local uptake of calcium, finally leading to lethal consequences. Conversely, the analysis of the mural cholesterol does not allow to discriminate arteriosclerotic from normal coronary artery segments. Thereby, conventional human coronary plaques typically represent a calcium-dominated type of human arteriosclerosis and differ widely from plaques produced in cholesterol-fed rabbits. The results indicate the decisive pathophysiological role of calcium and calcium overload in both calcium-dominated types of experimental arteriosclerosis and conventional human coronary artery plaques. Moreover, the antiarteriosclerotic effects of calcium antagonists are demonstrated to be based — in various types of experimental arteriosclerosis — on the inhibition of intra-and extracellular calcium overload of arterial walls evoked by various risk factors (vitamin D₃ intoxication, hypertension, nicotine, diabetes).     

Normal Sinus Rhythm in a Patient with Corrected Transposition of Great Arteries After 30 Years of Complete Heart Block

A case of a patient with corrected transposition of great arteries with complete atrioventricular block for 29 years who was in sinus rhythm.     

Role of Vitamin D Glucosiduronate in Calcium Homeostasis

Evidence has been presented suggesting the presence of vitamin D(3) 3beta-glucosiduronate and 1,25-dihydroxyvitamin D(3) glucosiduronate in rat bile. To evaluate the role of vitamin D glucosiduronates in calcium and phosphorus homeostasis, we synthesized vitamin D(3) 3beta-glucosiduronate and tested its biological activity in calcium- and vitamin D-deficient rats. After the intravenous administration of vitamin D(3) 3beta-glucosiduronate to rats maintained on a low calcium diet, there was an increase in duodenal calcium transport and an increase in serum calcium. Vitamin D(3) 3beta-glucosiduronate, however, was less active than equimolar amounts of vitamin D(3). At doses of less than 0.65-1 nmol per rat, the conjugate exhibited no activity. When vitamin D(3) 3beta-glucosiduronate was administered to vitamin D-deficient rats, 25-hydroxyvitamin D was detected in the serum; the increase in serum 25-hydroxyvitamin D levels was less than that observed after the administration of an equimolar amount of vitamin D(3). Vitamin D(3) 3beta-glucosiduronate showed no detectable activity in the induction of calcium binding protein in chick embryonic duodena, a system in which no endogenous steroid beta-glucuronidase activity is detectable. These data demonstrate that vitamin D(3) 3beta-glucosiduronate is biologically active in vivo and that the observed activity is due to hydrolysis of the conjugate to vitamin D(3). As vitamin D(3) 3beta-glucosiduronate is excreted in the bile of rats, it is possible that this conjugate is reutilized in vivo after hydrolysis to free vitamin D(3). These results suggest the existence of a mechanism for reutilization of the biliary products of vitamin D(3).     

X线胸片正常的咯血患者纤支镜检查诊断价值

笔者于1993年10月～2000年12月间对X线胸片正常的咯血患者93例进行了纤支镜检查,现总结报告如下:     

Monomorphic Ventricular Tachycardia Caused by Electrocautery during Pacemaker Generator Change in a Patient with Normal Left Ventricular Function

Pacemaker generator replacement is a simple procedure that is mostly done on outpatient basis. Electrocautery is almost universally used for bleeding control and tissue dissection. Ventricular fibrillation (VF) caused by electrocautery in these procedures is a very uncommon occurrence and an underappreciated possibility with modern day devices. We report a case of monomorphic ventricular tachycardia induced by electrocautery in a patient with normal left ventricular ejection fraction during elective pacemaker generator change.     

电压依赖性钙通道参与大振幅微小兴奋性突触后电流形成的实验研究

目的观察电压依赖性钙通道是否作用于大鼠脊髓背角胶状质层(SG)神经元大振幅微小兴奋性突触后电流的形成。方法选用成年雄性Sprague-Dawley(SD)大鼠,2%～3%异氟烷麻醉后,分离其腰骶部的脊髓,然后切片。采用全细胞电压钳技术,玻璃微电极的电阻为4～6 MΩ,钳制电压为70 mV,记录胶状质层神经元微小兴奋性突触后电流(mEPSC)电流。将电流信号用Axopatch 200来放大并储存于电脑。对照组和用药结束后,持续采样mEPSC电流30 s。mEPSC电流的频率和振幅用Clampfit 8.1进行分析。结果钳制电压为70 mV时,所有SG神经元均有自发性的EPSC。辣椒素增加mEPSC发生的频率和波幅。钴离子抑制辣椒素诱导的大振幅mEPSC。钴离子抑制辣椒素诱导的mEPSC的平均振幅,而不抑制其发生频率。结论电压依赖性钙离子通道参与了辣椒素引起的痛觉形成。     

大剂量纳洛酮抢救急性CO中毒的疗效观察

目的:探讨不同剂量纳洛酮在急性CO中毒中的疗效。方法:本研究62例急性CO中毒患者按常规量及大剂量治疗,观察两组病例在平均催醒时间及症状消失时间和毒副反应方面有无差异。结果:两组病例在平均催醒时间,症状消失时间方面差别显著(P<0.01),两组病例均无明显毒副反应。结论:大剂量组从平均催醒时间及症状消失时间均优于常规剂量组,毒副反应少。