自体心包片成形术治疗先天性三尖瓣关闭不全

采用自体心包片成形术治疗７例瓣或后瓣发育不良，或缺损面积较大，自身瓣膜成形困难的先天性三尖瓣畸形患者。术后心功能及超声检查恢复良好，自体心包片有取材方便，无不良反应，不引起血液破坏等优点，提出该术的应用指片及范围。     

无支架自体心包瓣置换主动脉瓣术后左心功能评价

目的 :评价无支架自体心包瓣植入后血液动力学特性。　　方法 :观察无支架自体心包瓣 (自体心包瓣组 )置换主动脉瓣病人 10例围术期血液动力学指标及术后近期左心功能变化 ,并与双叶机械瓣 (双叶机械瓣组 )置换主动脉瓣病人比较。　　结果 :自体心包瓣组病人围术期血液动力学指标优于双叶机械瓣组 ,而且术后瓣膜有效开口面积大 ,跨瓣压差小 ,病人左心室功能和构型恢复较快 ,2年心包瓣膜功能良好。　　结论 :无支架自体心包瓣具有良好的血液动力学特性 ,手术近期效果满意 ,远期效果有待进一步随访。     

应用自体肺动脉瓣置换病变主动脉瓣（附4例报告）

应用自体肺动脉瓣置换病变主动脉瓣、同种肺动脉瓣原拉重建右室流出道（Ross手术）治疗4例主动脉瓣病变患者,成功3例。1例主动脉瓣二瓣化畸形术后存在轻度主动脉瓣返流。超声心动图均提示主动脉根部及同种瓣良好。1例术中误伤自体肺动脉瓣,改机械瓣置换。认为用自体肺动脉瓣置换病变主动脉瓣效果满意,术中预防自体肺动脉瓣损伤和主动脉瓣返流是手术成功的关键,同种肺动脉瓣原位重建右室流出道可为常规选择的管道。     

右心瓣膜感染性心内膜炎的外科治疗

目的：总结右心系统瓣膜心内膜炎的特点和手术处理经验。方法：回顾性分析右心系统瓣膜感染性心内膜炎１７例,其侵犯三尖瓣６例、肺动脉瓣４例,同时侵犯三尖瓣＋肺动脉瓣３例,肺动脉瓣＋主动脉瓣３例,主动脉瓣、二尖瓣、三尖瓣与肺动脉瓣同时受累１例。合并心脏畸形１４例,室间隔缺损修补术后、主动脉窦瘤破裂修补术后、起博器安置术后各１例。施行三尖瓣瓣膜游离缘或瓣膜赘生物切除直接缝合５例、三尖瓣瓣膜赘生物切除用自体心包片修补２例、部分瓣叶和瓣下结构切除缝合瓣叶并行人工腱索成形术１例,施行三尖瓣置换术２例;单纯行肺动脉瓣瓣叶赘生物切除４例,部分肺动脉瓣切除用自体心包片瓣叶成形术６例,切除肺动脉瓣用自体心包瓣置换１例。结果：术后早期死亡２例,病死率为１２％,术后早期并发急性肾功能不全３例,肝功能不全１例。术后随访５个月～１８年,平均随     

自体心包瓣膜成型术的临床研究

目的探讨应用自体心包进行心脏二尖瓣、三尖瓣瓣膜成型的技术特点和可行性,评价其术后效果.方法2005-01-2006-06我院采用自体心包成型心脏瓣膜6例,其中男性4例,女性2例.先天性心脏病室间隔缺损合并感染性心内膜炎致三尖瓣关闭不全2例,致二尖瓣关闭不全1例;黏液变性二尖瓣关闭不全3例.4例二尖瓣病变采用了双孔成型技术,同时用自体心包片制作成型环,替代人造瓣环或自体心包片修补后叶.2例三尖瓣病变用自体心包片修补三尖瓣前瓣叶以及隔瓣,瓣环再行De vaga环缩.结果6例患者均顺利出院.随访3个月.术后二尖瓣、三尖瓣返流程度均有明显改善(P<0.05).术后患者心功能均有明显提高(P<0.05).结论自体心包材料能最大限度的发挥瓣膜成型手术的优势,降低并发症,降低手术费用,近期效果良好,长期资料有待进一步的随访.     

应用自体心包瓣膜成型

目的 探讨应用自体心包进行心脏二尖瓣、三尖瓣瓣膜成型的技术特点和可行性,评价其术后效果.方法 2005年1月至2006年6月我院采用自体心包成型心脏瓣膜6例,其中男性4例,女性2例.先天性心脏病室间隔缺损合并感染性心内膜炎致三尖瓣关闭不全2例,致二尖瓣关闭不全1例;黏液变性二尖瓣关闭不全3例.4例二尖瓣病变采用了双孔成形技术,同时用自体心包片制作成形环,替代人造瓣环或自体心包片修补后叶.2例三尖瓣病变用自体心包片修补三尖瓣前瓣叶以及隔瓣,瓣环再行De vaga环缩.结果 6例患者均顺利出院,随访3个月.术后患者二尖瓣、三尖瓣反流程度均有明显改善(P＜0.05),心功能均有明显提高(P＜0.05).结论 自体心包材料能最大限度地发挥瓣膜成型手术的优势,降低并发症和手术费用,近期效果良好.     

自体心包三尖瓣成形术4例报告

对4例三尖瓣瓣叶发育不良、缺如或瓣叶、瓣下结构毁损患者行自体心包三尖瓣成形术.2例Eb-stein's畸形行新鲜自体心包片修复三尖瓣前瓣及腱索转移技术,同时准确测量三尖瓣隔瓣环长度(SL),按照1.75倍SL修剪经0.2%戊二醛处理的自体心包片用于精确环缩三尖瓣前瓣环及后瓣环,同期行继发孔房间隔缺损修补手术、"缘对缘"三尖瓣成形手术各1例.2例三尖瓣细菌性心内膜炎病变者采用病变瓣叶切除,新鲜自体心包片修复瓣叶及人工腱索技术;同期行"缘对缘"三尖瓣成形术1例.结果 无手术死亡;出院前心脏超声检查示三尖瓣启闭良好,无反流或残留微量反流;随访4～24个月,微至少量反流3例,少至中量反流1例.心包片替代的三尖瓣前叶活动尚好,无增厚,无钙化.证明三尖瓣器质性病变应用自体心包片行瓣环成形术、瓣叶成形术早期效果良好,远期效果有待观察.     

带蒂肌瓣修补治疗老年食管胃吻合口瘘15例

食管胃吻合口瘘是食管癌手术的严重并发症,对于老年患者后果尤其严重,往往导致患者术后死亡.对于瘘口较大的患者常需二次手术修补,单纯修补常难以愈合,需要应用自体材料修补,而应用何种自体材料修补效果更好目前尚未形成共识.笔者2001年7月至2008年9月对15例老年食道癌术后吻合口瘘患者行带蒂胸大肌肌瓣或肋间肌瓣修补治疗,取得了满意效果.     

酒精保存颅骨瓣修补颅骨缺损56例临床观察

颅骨缺损是各种颅脑损伤术后常见的并发症之一。我院自１９９６年开始用酒精保存自体或同种异体颅骨瓣,然后用于修补颅骨缺损共５６例,现报告如下。资料与方法：治疗组５６例,男３９例,女１７例;年龄１８～５９岁,平均３１岁;其颅骨缺损修补用自体颅骨瓣４２例、同...     

人造单瓣补片扩大右室流出道根治法洛氏四联症的近期疗效

本对重症法洛氏四联症采用人造单瓣补片扩大右室流出道进行根治术。病例共４０例,随机分为Ａ、Ｂ两组。Ａ组为带瓣组,采用带自体心包单瓣进行跨肺动脉瓣扩大右室流出道。Ｂ组为对照组,用相应大小自体心包进行跨肺动脉瓣扩大右室流出道。观察两组病例在术前、术后一周、术后３个月及６个月的心电图、Ｘ线胸片及心脏超声检查指标,比较两组病例肺动脉瓣返流面积和心功能变化。结果显示带瓣组肺动脉瓣返流面积术后一周、３个月及６     

Secretion of the intestinotropic hormone glucagon-like peptide 2 is differentially regulated by nutrients in humans

Background & Aims: Glucagon-like peptide 21, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33 (GLP-21, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33), an intestinally derived hormone, stimulates growth in rodent small and large bowel. To explore the physiology of GLP-21, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33 secretion, we measured plasma GLP-2 levels in 6 healthy male volunteers, before and after test meals. Methods: Blood samples were collected over 24 hours with the subjects consuming a normal, solid mixed diet (2500 kcal) and for 4 hours after liquid test meals (400 kcal/300 mL) composed of carbohydrate, fat, or protein. All studies commenced at 9 AM. Plasma was extracted and analyzed in radioimmunoassays for N-terminal immunoreactive GLP-2 (N-IR-GLP-2; measures bioactive GLP-21, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33) as well as total IR-GLP-2 (T-IR-GLP-2), which includes GLP-21, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, GLP-23, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33 (an inactive degradation product of GLP-21, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33), and the pancreatic major proglucagon fragment (an inactive precursor that contains GLP-2). Basal and nutrient-stimulated plasma samples were also analyzed by high-performance liquid chromatography to determine the levels of GLP-21, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33 and GLP-23, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33. Results: N-IR-GLP-2 levels were increased 2.0 ± 0.2– to 2.8 ± 0.5–fold 40 minutes after each mixed meal (P < 0.05–0.01) and returned to basal overnight, whereas T-IR-GLP-2 levels were increased 1.3 ± 0.1–fold 40 minutes after breakfast only (P < 0.05). After ingestion of carbohydrate or fat alone, plasma N-IR-GLP-2 concentrations increased by 5.6 ± 2.0– and 2.7 ± 0.6–fold within 1 hour (P < 0.05). High-performance liquid chromatography analysis showed a relative increase in the levels of GLP-21, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33 compared with GLP-23, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33 (P < 0.05). Ingestion of the protein meal did not alter N-IR-GLP-2 levels, whereas T-IR-GLP-2 was increased by fat and protein (by 1.7 ± 0.2–fold for each, P < 0.01) but not by carbohydrate. Conclusions: These results show that secretion of GLP-21, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33 from the intestine is regulated in a nutrient-dependent manner in normal humans.GASTROENTEROLOGY 1999;117:99-105     

First‐Step Use of Fixed‐Dose Combination Treatment in Stage 2 Hypertensive Patients: Has the Time Come?

A panel discussion was convened on February 14, 2007, to discuss the use of fixed-dose combination therapy for stage 2 hypertensive patients. The panel was moderated by Michael A. Weber, MD, Professor of Medicine, SUNY Downstate College of Medicine, New York, NY. Participants included Luis Ruilope, MD, Chief, Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain, Thomas D. Giles, MD, Professor of Medicine, Tulane University School of Medicine, Metairie, LA, and Joseph L. Izzo, Jr, MD, Professor of Medicine, Department of Medicine, State University of New York at Buffalo, Buffalo, NY.     

Myocardial infarction Changes in the concentrations of high-energy compounds and free amino acids in erythrocytes

Quantitative determination of the nucleotides AMP, ADP, ATP, GTP, NAD, NADP, 2,3-DPG and the free amino acids Lys, His, Gly, Ala, Val, Met, Phe, Tyr, Pro, Thr, Ser, Glu, Asp in erythrocytes was carried out in early and late stages of myocardial infarction. It was found that in erythrocytes, in the early stage of myocardial infarction, the concentrations of AMP, NADP and 2,3-DPG increased, whereas those of ADP, ATP, GTP and NAD decreased. In the third week of the disease the concentrations of AMP, ADP, NADP, and especially 2,3-DPG remained high, while those of ATP and GTP shifted towards the control. The concentrations of His, Gly, Ala, Val, Met, Phe, Thr and Glu increased, while those of Tyr, Ser and Asp decreased in the first stage of myocardial infarction. At the later stage of the illness (21 days) the concentrations of free amino acids returned to normal.     

Abstracts of papers on haemophilia from other journals

Incidence of factor VIII inhibitor development in hemophilia A patients treated with less pure plasma derived concentrates. de Biasi R, Rocino A, Papa, ML, Salerno E, Mastrullo L, De Blasi D.
Rapid clearance of hepatitis C virus RNA in peripheral blood mononuclear cells of patients with clotting disorders and chronic hepatitis C treated with alpha-2b interferon is not a predictor for sustained response to treatment. Peerlinck K, Willerns M, Sheng L, Nevens F, Fevery J, Yap SH, Verrnylen J.
Factor VIII gene rearrangements in patients with severe haemophilia A. Goodeve AC, Preston FE, Peake IR.
Immune status of human immunodeficiency virus seropositive and seronegative hemophiliacs infused for 3.5 years with recombinant factor VIII. Mannucci PM, Brettler DB, Aledort LM, Lusher JM, Abildgaard CF, Schwartz RS, Hurst D and the Kogenate Study Group.
The role of platelet von Willebrand factor in platelet adhesion and thrombus formation: a study of 34 patients with various subtypes of type I von Willebrand disease. Fressinaud E, Federici AB, Castaman G, Rothschild C, Rodeghiero F, Baumgartner HR, Mannucci PM, Meyer D.
Two controlled trials of rifabutin prophylaxis against Mycobacteriurn aviurn complex infection in AIDS. Nightingale SD, Cameron DW, Gordin FM, Sullam PM, Cohn DL, Chaisson RE, Eron LJ, Sparti PD, Bihari B, Kaufman DL, Stern JJ, Pearce DD, Weinberg WG, LaMarca A, Siegal FP.
Three-year randomised study of high-purity or intermediate-purity factor VIII concentrates in symptom-free HIV-seropositive haemophiliacs: effects on immune status. Seremetis SV, Aledort LM, Bergman GE, Bona R, Bray G, Brettler D, Eyster ME, Kessler C, Lau T-S, Lusher J, Rickles F.     

Book Reviews

Cytokines in Health and Disease, Second Edition, Edited by D. G. Remick and J.S. Friedland, Marcel Dekker, Inc., 1997, 704 Pages, $195.00, ISBN 0-8247-9823-6

Rheumatology, 2nd Edition, Edited by John H. Klippel and Paul A. Dieppe, Mosby, London, 1998, 1,920 pages, $269.00, ISBN 0-7234-2405-5

Advances in Cardiomyopathies, Edited by F. Camerini, A. Gavazzi and R. De Maria, Springer-Verlag, 1998, 317 Pages, $129.00, ISBN 8847000092

International Review of Cytology: A Survey of Cell, Biology, Edited by K. W. Jeon, Academic Press, 1999, 291 Pages, $89.95, ISBN 0-12-364591-3     

幽门螺杆菌5种候选疫苗抗原基因的克隆、表达及抗原性的鉴定

目的:构建含人Hpylori5种候选疫苗抗原Lpp20,HspA,UreaseA,CagA,UreaseB的编码基因的重组质粒并研究其抗原性.方法:应用PCR技术从Hpylori染色体中扩增编码Lpp20,HspA,UreaseA,CagA,UreaseB的基因片段,将其T-A克隆和测序,并与GenBank公布的其他Hpylori菌株基因序列比较,再将目的基因克隆至融合表达载体pGEX-4T-1上中进行表达,用GST亲和层析对其进行纯化,纯化产物用于对29株小鼠抗Hpylori-全菌单克隆抗体(mAb)的鉴定及与Hpylori感染患者血清进行Westernblot分析.结果:扩增的Lpp20,HspA,UreaseA,CagA,UreaseB基因全长分别为528bp,351bp,675bp,855bp,1704bp(GenBank登录号分别为DQ106902,DQ141574,DQ141577,DQ141575,DQ141576),与GenBank公布的其他菌株的核酸序列的同源性在95%-99%,表达Lpp20,HspA,UreaseA,CagA,UreaseB融合蛋白的相对分子质量分别约为48000,41000,52000,60000,91000Da,29株小鼠抗Hpylori全菌mAb中针对Lpp20,HspA,UreaseA,CagA,UreaseB抗原的分别为4,5,5,1,6株,5种抗原的纯化产物均可被Hpylori感染患者血清特异性识别.结论:重组表达的Lpp20,HspA,UreaseA,CagA,UreaseB均具有较好的抗原性.     

A basic study of Vibrio vulnificus infection: serotyping and drug sensitivity test of environment-derived strains and human clinical isolates

In attempt to elucidate the route and source of Vibrio vulnificus infection. serotyping and drug sensitivity tests of environment-derived strains and human clinical isolates were performed. 1) Serotyping of isolates from the two types of source were determined. Of environment-derived strains, 72.5% were classified into 18 types, and O7 was the most frequent type, accounting for 73.1%, and the second frequent type was O4, accounting for 6.1%. Of human clinical isolates, 87.1% were classified into eight types, and O4 was the most frequent, accounting for 73.5%, and O7 was the secondly most frequent, accounting for 12.9%. 2) Serotypes were investigated by regions. In eastern Japan, 69.2% were classified into 18 types, and O7 and O4 accounting for 44.6% and 5.7%, respectively. In western Japan, 64.8% were classified into eight types, and O7 was the most frequent, accounting for 20.4%, and secondly frequent type was O4, accounting for 11.1%. 3) Regarding the relationship between biotypes and serotypes, environment-derived biotype-I strains were widely distributed in the serotypes, but most biotype-I human clinical isolates were distributed in serotypes O1-O7, showing a difference between the two types of sources. However, many biotype-II strains from the two types of sources included in the serotype O7 group. 4) Drug sensitivity was compared based on MIC90 between strains from the two types of sources. Environment-derived strains were sensitive to ABPC, PIPC, CPZ, CTX, LMOX, MEPM, GM, EM, TC, DOXY, MINO, CP, NA and CPFX, but some strains were resistant to CER, CET, CTX, CMZ, KM and LCM. Human clinical isolates were sensitive to EM, TC, DOXY, MINO, CP, NA and CPFX, but some strains were resistant to ABPC, PIPC, CER, CET, CPZ, CTX, CMZ, LMOX, MEPM, KM, GM, AMK and LCM.     

A prediction model for moderate or severe dehydration in children with diarrhoea

A hospital-based unmatched case-control study (387 cases and 387 controls) was carried out at the Government Medical College Hospital, Nagpur, India, to devise and validate a risk-scoring system for predicting the development of moderate or severe dehydration in children, aged less than five years, with acute watery diarrhoea. On unconditional multiple logistic regression, 12 risk factors--infancy, minority religion, undernutrition, not washing hands by mother before preparation of food, frequency of stools > 8/day, frequency of vomiting > 2/day, measles in previous 6 months, withdrawal of breast-feeding/other feedings, withdrawal of fluids during diarrhoea, not giving oral rehydration solutions (ORS), home available fluids and both during diarrhoea--were significant. Based on regression coefficients, these factors were ascribed statistical weights of 5, 5, 4, 4, 22, 9, 11, 13, 5, 5, 5, and 7 respectively. The receiver-operating characteristic curve suggested a total score of 48 to be the best cut-off for predicting the development of moderate or severe dehydration. At this cut-off, the sensitivity, specificity, positive predictive value, Cohen's kappa, and overall predictive accuracy were 0.81, 0.81, 0.81, 0.61, and 0.86 respectively. If substantiated by further validation, this system can be used for predicting the development of dehydration at the earlier stage, thereby reducing the mortality associated with life-threatening dehydration.     

The neurotoxicity of antibacterial agents

Commonly used antibacterial agents may be associated with various neurotoxic reactions. Central nervous system toxicities include seizure disorders, encephalopathy, bulging fontanelles, and neuropsychiatric symptoms. These abnormalities have been associated with the use of the penicillins, cephalosporins, sulfonamides, tetracyclines, chloramphenicol, colistin, aminoglycosides, metronidazole, isoniazid, rifampin, ethionamide, cycloserine, and dapsone. Cranial nerve toxicities, such as myopia, optic neuritis, deafness, vertigo, and tinnitus, have been associated with the use of erythromycin, sulfonamides, tetracyclines, chloramphenicol, colistin, aminoglycosides, vancomycin, isoniazid, and ethambutol. Peripheral nerve symptoms consisting of paresthesias, motor weakness, or sensory impairment have been associated with the use of the penicillins, sulfonamides, chloramphenicol, colistin, metronidazole, isoniazid, ethionamide, and dapsone. Neuromuscular blockade has been associated with the use of the tetracyclines, polymyxins, lincomycin, clindamycin, and aminoglycosides. Management generally consists of supportive therapy and immediate discontinuation of therapy with the offending drug.     

How to treat hypertension in patients with coronary heart disease disease

Following a hypertension symposium in Los Angeles in October 2007, a panel was convened to discuss how to treat hypertension in patients with coronary artery disease or with evidence of multiple major risk factors for coronary heart disease. Marvin Moser, MD, Clinical Professor of Medicine at the Yale University School of Medicine, New Haven, CT, moderated the discussion. Jackson T. Wright Jr, MD, PhD, Professor of Medicine, Program Director of William T. Dahms Clinical Research, and Director of the Clinical Hypertension Program at Case Western Reserve University, Cleveland, OH; Ronald G. Victor, MD, Professor and Division Chief, Hypertension, University of Texas Southwestern Medical Center, Dallas, TX; and Joel Handler, MD, Hypertension Lead, Care Management Institute, Kaiser Permanente, Anaheim, CA, participated in the discussion.