de Winter综合征1例

正1病例患者男性,48岁,主因"突发心前区疼痛4 h"就诊于北京王府中西医结合医院急诊,行心电图示(图1):Ⅱ、aVF、V2-6导联ST段上斜型压低,V2-6导联T波高耸,急查肌钙蛋白(TNI)示:2.03μg/L(正常值0.11μg/L),考虑急性冠状动脉(冠脉)综合征不除外,急请心内科会诊,经心电图并结合肌钙蛋白水平,考虑患者为de Winter综合征心电图改变,建议急行冠脉造影术,必要时行经皮冠脉介     

抗磷脂综合征合并冠状动脉血栓1例

1临床资料患者男,26岁。因“头痛8 d,胸痛6 d”2017年7月17日就诊于北京协和医院。2017年7月10日患者无明显诱因出现持续性头痛,左侧为著,伴头晕。7月12日患者劳累后出现胸痛,症状持续不缓解。7月16日患者就诊外院,查心电图示:窦性心律,Ⅱ、Ⅲ、aVF导联ST段压低、T波倒置。心肌损伤标志物示:肌酸激酶1087 U/L,肌酸激酶同工酶62.9μg/L,心肌肌钙蛋白I 4.2μg/L。头部核磁共振示:左侧小脑半球软化灶。7月17日患者至北京协和医院急诊就诊,测血压88/59 mmHg(1 mmHg=0.133 kPa),心率84次/分,余心肺腹查体(−)。心电图示:交界性自主心律,室率78次/分,Ⅲ导联Q波形成,Ⅱ、Ⅲ、aVF、V4~V6导联T波倒置(图1)。心肌损伤标志物示:肌酸激酶1240 U/L,肌酸激酶同工酶91.2μg/L,心肌肌钙蛋白I 15.458μg/L。     

ST段呈动态演变的de Winter综合征一例

<正>1病例资料患者男性,43岁,因"突发胸痛6 h"于2017年11月23日入院。患者入院6 h前劳累后突感胸痛,持续不可缓解,由急救车送入我院急诊,急救车中行心电图示Ⅱ、a VF、V2~V6导联J点下移,伴ST段上斜型压低,a VR导联ST段轻度抬高(图1)。收入我院急诊查心肌酶学显示:肌钙蛋白(Tn I)1.48μg/L,肌酸激酶同工酶MB(CK-MB)52.4 ng/ml,     

真分叉病变术中并发冠状动脉穿孔一例

1临床资料患者男,72岁,因"突发心前区疼痛、憋喘12 h余"入院。查体:血压134/74 mm Hg(1 mm Hg=0.133 k Pa),心率70次/min,双下肺可闻及湿性啰音,余无其他阳性体征。心电图示:Ⅰ、a VL、V3~V6导联T波倒置。超敏肌钙蛋白2.65μg/L(正常值<0.11μg/L)。诊断:冠心病,急性心肌     

冠状动脉介入治疗术后T波假性正常化1例

患者,女,57岁,主因突发胸痛5h入院。入院前患者情绪激动时突发心前区闷痛,伴下颌部不适,持续不缓解。既往高血压史10年。体检:脉搏80次/min,血压140/70mmHg(1mmHg=0.133kPa),双肺无音,心脏各瓣膜听诊区无病理性杂音。入院时急查心电图(图1)显示:aVL呈qrs型,V1、V2呈QS型,V3呈rS型,V2、V3、V5导联ST段弓背向上抬高0.1~0.15mV,I、aVL、V1~4导联T波倒置,V5导联T波正负双向。心肌标志物:肌酸激酶同工酶(CK-MB)>80.0μg/L,肌钙蛋白20.2μg/L。入院诊断:急性前壁心肌梗死。急诊冠状动脉造影显示冠状动脉前降支近段局限狭窄90%,远段…     

第19例:临床表现反复胸痛

<正>患者男性,16岁。因反复胸痛2周于2011年9月20日入院。患者入院前2周无明显诱因急性胸痛发作,为心前区剧烈的压榨样疼痛,持续2 h不缓解。外院心电图(ECG)示Ⅱ、Ⅲ、aVF、V_7～V_9导联ST段抬高,V_1～V_4导联ST段压低,心肌酶升高,肌钙蛋白I(cTnI)5.72μg/L、肌酸激酶同工酶(CK-MB)>80μg/L,考虑急性冠状动脉综合征,予抗血小板、抗凝、扩血管、营养心肌后症状缓解,此后无规律用药。此次发作前曾有咳嗽、咳痰,无发热、咯血。入院当天零点再次急性胸痛发作,性质同前,发作12h未缓解急诊就诊。查     

蹊跷的心肌梗死1例

<正>1 临床资料患者女性,71岁,以“胸闷7 h”为主诉入院,患者于7 h前(2020-08-28 17:30)劳动后出现胸闷症状,位于胸骨后,持续不缓解,伴头晕、恶心、呕吐,自测血压80/50 mm Hg(1 mm Hg=0.133 kPa),遂急诊于当地县医院,监测血压112/64 mm Hg, 查超敏肌钙蛋白I 8.64(参考值<0.04)μg/L,心电图提示V1～V5导联ST段抬高,考虑急性心肌梗死,予“阿司匹林0.3 g,     

急性心肌梗死合并心力衰竭应用脉搏指示连续心排血量监测及主动脉球囊反搏治疗1例

<正>患者:男,76岁。因"持续胸闷2 d,头晕15 h"于2013年10月收入心脏病重症监护病房(CCU)。患者2 d前活动时感胸闷、乏力,休息10~20 min症状可缓解,未就诊。15 h前感头晕,胸闷逐渐加重来我院急诊。心电图检查示Ⅱ、Ⅲ、aVF、V7~V9导联ST段抬高,二度Ⅰ型房室传导阻滞,心室率50次/min。血肌酸激酶同工酶(CK-MB)193 U/L,肌钙蛋白(Tn)I 8.4μg/L,血清肌酐(Cr)252μmol/L。诊断为"急性下壁、后壁心肌梗死,二度Ⅰ型房室传导阻滞,心力衰竭     

低血糖引发心电图一过性ST段抬高1例

患者,男,65岁,因反复口干、乏力10年,加重1月,于2011年8月27日入院.查体:血压106/62 mmHg,入院即刻血糖19.8 mmol/L,心电图:心率74次/min,窦性心律,心电轴左偏,完全左束支传导阻滞.血液生化检查:肌钙蛋白Ⅰ 0.02μg/L,CK-MB 1.58 μg/L,诊断:糖尿病;冠心病. 9月1日患者行动态心电图及动态血压监测时突发头晕、恶心、无力、大汗淋漓.查血压192/95mmHg,5min后复测血压204/104 mmHg.即时心电图(图1)示:心率99次/min,窦性心律,心电轴左偏,完全左束支传导阻滞,V1～V3导联ST段抬高,T波高尖;与8月27日心电图(图2)对比:V1 ～ V3导联ST段分别抬高0.15、0.15、0.3 mV,V1～V3导联T波较前分别增高0.15、0.25、0.5 mV,患者当日晨起血糖3.38 mmol/L;血液生化:尿素氮8.67 mmol/L,LDH 253 U/L;肌钙蛋白0.033 μg/L.9月2日动态心电图(图3)又恢复到低血糖反应发生前的图形.     

极晚期支架贴壁不良及断裂一例

患者女,57岁.因"持续胸痛13 h"急诊入院.血压99/60 mm Hg(1 mm Hg=0.133 kPa).心电图示Ⅱ,Ⅲ,aVF导联ST段下斜型抬高,V1～V3导联R波递增不良.肌酸激酶-MB 22.4μg/L,肌红蛋白278μg/L,肌钙蛋白10.90 μg/L,考虑非ST段抬高型心肌梗死.     

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.