急性前壁心肌梗死下壁导联ST段压低的临床价值

目的 探讨急性前壁透壁性心肌梗死时下壁导联ST段压低的临床价值。方法 比较任一下壁导联ST段压低≥1.0mm的17例与压低均＜1．0mm的16例的CK－MB值、超声心动描记术、冠状动脉造影等结果。结果 前组CK－MB值更高,射血分数减低更显著,左室收缩与舒张末期容积更大,造影术示致梗死狭窄病变多位于左前降支近端或呈多支病变。结论 急性前壁心肌梗死下壁导联ST段压低≥1.0mm时,其梗死面积较大,会发生较严重的左室射血功能损害及左心室重构。     

急性下壁心肌梗死患者心电图胸前导联ST段改变的临床意义

目的探讨急性下壁心肌梗死患者心电图胸前导联ST段改变与冠状动脉造影(CAG)所见冠状动脉病变部位的关系及其临床意义。方法 187例急性下壁心肌梗死患者,按入院时18导心电图胸前导联ST段改变分为3组,ST段无变化组(47例),ST段抬高组(16例),ST段压低组(124例);所有患者均行CAG。结果急性下壁心肌梗死伴胸前导联ST段抬高时多为右冠状动脉(RCA)近段闭塞(14例,82.3%),尤其是伴圆锥支动脉闭塞,与RCA中远端闭塞(2例,5.9%)比较差异有统计学意义(P0.01),且14例(73.7%)伴有右心功能不全和血流动力学障碍。下壁心肌梗死胸前导联ST段压低者可见于RCA、回旋支(LCX)闭塞及RCA、LCX闭塞与前降支(LAD)、对角支(D)病变的不同组合,其中LCX闭塞伴RCA病变者多表现为朐前ST V_4～V_6的压低,RCA闭塞伴LAD近端病变多有胸前ST V_1～V_6的压低,RCA伴D病变胸前ST V_1～V_3压低,与对照组比较差异有统计学意义(P0.05)。结论急性下壁心肌梗死合并胸前导联ST段抬高表明为RCA近段或丌口闭塞且多伴右心室心肌梗死和心功能不全;下壁心肌梗死伴胸前导联ST段压低提示为多支病变,ST V_1～V_3压低多伴有对角支严重狭窄,STV_1～V_6压低多伴有前降支的严重狭窄。     

心电图改变对急性下壁心肌梗死相关血管的预测价值

目的:对急性下壁心肌梗死患者的心电图资料进行回顾性研究,分析和比较心电图改变与冠状动脉造影及临床特点的对应性关系。探讨体表心电图改变对急性下壁心肌梗死患者的临床价值。方法:选取86例急性下壁心肌梗死患者,根据冠状动脉造影结果分为右冠状动脉(RCA)病变组和左冠状动脉(LCA)病变组。对比分析其心电图改变与冠状动脉造影结果及临床特点。结果:Ⅰ、Ⅱ、Ⅲ、aVR导联ST段及aVL导联波形改变对诊断梗死相关血管具有重要价值;V3与Ⅲ导联ST段改变比值预测梗死相关血管部位具有重要价值;伴aVR导联ST段压低患者病情重;伴胸前导联ST段压低者病情重、并发症发生率明显增高。结论:心电图对诊断下壁急性心肌梗死相关血管及其临床特点具有重要的预测价值。     

胸前导联合并Ⅱ、Ⅲ、avF导联ST段抬高的急性心肌梗死患者的临床和冠状动脉造影特点

目的：研究胸前导联合并Ⅱ、Ⅲ、avF 导联 ST 段抬高的急性心肌梗死患者的梗死相关动脉,评估其梗死面积和左心室功能减退程度,探讨如何通过心电图判断其梗死相关动脉。方法：将354例心电图表现为胸前导联 ST 段抬高的急性心肌梗死患者分为3组：A 组,胸前导联合并Ⅱ、Ⅲ、avF 导联 ST 段抬高(n=59),并根据梗死相关动脉进一步分为右冠状动脉闭塞者和左冠状动脉前降支闭塞者；B 组,单纯胸前导联 ST 段抬高(n=151)；C 组,胸前导联 ST 段抬高合并Ⅱ、Ⅲ、avF 导联 ST 段压低(n=144)。测定肌酸激酶(CK)和肌酸激酶 MB 同工酶(CK-MB),超声心动图测定左心室射血分数(LVEF),通过冠状动脉造影判断梗死相关动脉。结果：A 组的梗死相关动脉分别为右冠状动脉,约56%；左冠状动脉前降支,约37%。其中,右冠状动脉闭塞者,闭塞部位多为右冠状动脉近段,ST 段抬高幅度在Ⅲ导联＞Ⅱ导联,在V_1导联＞V_3导联；左冠状动脉前降支闭塞者,闭塞部位多为左冠状动脉前降支中远段,ST 段抬高幅度在 V_3导联＞V_1导联。B 组和 C 组梗死相关动脉几乎均为左冠状动脉前降支(分别为96%和95%)。与其他两组相比,A 组 ST 段抬高的导联数最多,但 CK-MB 峰值最低,LVEF 值最高。结论：胸前导联合并Ⅱ、Ⅲ、avF 导联 ST 段抬高的急性心肌梗死,可能是由右冠状动脉近段闭塞或环绕心尖部的左冠状动脉前降支远段闭塞引起的。其心肌梗死面积相对较小,心功能受损较少。在这些患者中,如果Ⅱ、Ⅲ、avF 导联 ST 段抬高的总幅度较大,ST 段抬高幅度在Ⅲ导联＞Ⅱ导联,在 V_1导联＞V_3导联,梗死相关动脉为右冠状动脉的可能性较     

急性前壁心肌梗死下壁导联ST段变化与前降支形态和梗死部位的关系

目的探讨急性前壁心肌梗死时下壁导联ST段的变化与不同前降支形态和梗死部位关系。方法根据下壁导联心电图ST段改变情况,将67例首发急性前壁心肌梗死病例分为ST段压低组,ST段抬高组和ST段无变化组,与冠状动脉造影结果对照,分析各组心电图变化与前降支形态和梗死部位的关系。结果梗死相关部位在前降支近端者ST段压低组中占81.25%,ST段抬高组占20%,ST段无变化组占46.34%(P<0.01);LAD返折支配1/4以上下壁在ST段压低组中占6.25%,ST段抬高组占70%,ST段无变化组占29.27%(P<0.01)。结论急性前壁心肌梗死时下壁导联ST;段变化与前降支梗死部位和形态有关。下壁导联ST段压低提示前降支近端梗死,ST段抬高提示前降支远端梗死且存在前降支返折。     

急性下壁心肌梗死伴左胸导联ST段压低的临床意义

的　探讨急性下壁心肌梗死伴胸导联 ST段压低的临床意义。方法　选择收住院并行冠状动脉造影术的首发急性下壁心肌梗死患者 88例 ,按照胸导联有无 ST段下移分为不伴胸导联 ST段压低组 45例 ( ST段无压低或 ST段压低 <0 .1m V)及伴胸导联 ST段压低组 43例 ( ST段压低≥ 0 .1m V)。结果　伴胸导联 ST段压低组合并心力衰竭、严重心律失常、低血压及住院病死率较不伴胸导联 ST段压低组明显增高 ,冠状动脉造影显示左前降支病变及多支病变者显著增多。结论　急性下壁心肌梗死伴胸导联 ST段压低者其临床合并症多 ,预后差 ,冠状动脉多支病变及合并左前降支病变者显著增多 ,临床上应高度重视。     

急性心肌梗死对应导联ST段变化与冠状动脉病变的关系

目的 用冠状动脉造影技术研究急性心肌梗死(AMI)对应导联ST段变化与冠状动脉病变的关系。方法136例急性心肌梗死共分五组:①组,前壁梗死(V1-6)伴有Ⅱ,Ⅲ,aVF导联ST段下移。②组,下壁梗死(Ⅱ,Ⅲ,aVF)同时伴有V1-6导联ST段下移。③组,下壁梗死(Ⅱ,Ⅲ,aVF)同时伴有I,aVL导联ST段下移。④组,前壁梗死(V1-6)未伴有其它导联的ST段变化。⑤组,下壁梗死(Ⅱ,Ⅲ,aVF)未伴有其它导联的ST段变化。所有患者均进行冠状动脉造影。结果 前壁心肌梗死伴有Ⅱ,Ⅲ,aVF导联ST段下移25例中有88%为左冠状动脉前降支病变,其中90.9%为左冠状动脉近端病变。前壁心肌梗死未伴有Ⅱ,Ⅲ,aVF导联ST段下移的36例患者中有94.4%为左冠状动脉前降支病变,两者统计无显著性差异。在下壁心肌梗死伴有V1-6导联ST段下移组22例中有81.8%为右冠状动脉病变,但同时伴有前降支病变的却有77.3%,其中单支病变仅18.2%。下壁心肌梗死未伴有V1-6导联ST段下移34例有91.2%为右冠状动脉病变,但同时伴有前降支病变的仅有32.4%,其中单支病变达52.9%。两组统计分别为P<0.001和P相似文献   

急性下壁心肌梗死伴有胸前导联ST段压低的临床意义

目的 分析急性下壁心肌梗死（acute inferior myocardial infarction,AIMI）伴有胸前导联ST段压低的冠状动脉病变特点及临床意义。方法 回顾分析2006年8月～2007年8月住院的AIMI患者91例。按胸前导联ST段是否压低将患者分为4组:胸前导联ST段无压低组（n=27）;胸前导联仅V1～4 ST段压低组（n=26）;胸前导联仅V5～6 ST段压低组（n=12）;广泛胸前导联ST段压低组（n=26）。结果 AIMI伴有胸前导联V1～4 ST段压低与冠状动脉多支病变呈负相关,ORⅢ=0.38,无统计学意义;AIMI伴有胸前导联V1～6 ST段压低与冠状动脉多支病变呈正相关,ORⅣ=5.25,P<0.01,有显著统计学意义。胸前导联V1～6 ST段压低组与其他组相比较,左室射血分数（LVEF）低,差异显著（P<0.05）;该组前降支病变率高（73.1%）,但与其他3组相比无统计学差异。结论 AIMI伴有胸前导联V1～6 ST段压低提示多支病变,且心功能不全发生率高。     

肢体导联ST段改变对急性前壁心肌梗死患者冠脉闭塞部位的预测价值

目的：结合冠状动脉造影结果分析肢体导联ST段改变对判断急性前壁心肌梗死患者冠脉闭塞部位的预测价值。方法入选84例因急性前壁梗死行冠状动脉造影检查的患者,对其发病后心电图肢体导联ST段改变的情况进行分析。结果冠状动脉造影发现,前降支近端病变（伴或不伴远端病变）,肢体导联Ⅱ、Ⅲ、aVF多表现为ST段压低≥0．1 mV;前降支远端病变（不伴近端病变）,肢体导联Ⅱ、Ⅲ、aVF的ST段多表现为抬高或无明显压低。结论对于急性前壁心肌梗死患者,心电图肢体导联ST段改变可以预测冠状动脉闭塞部位,对早期诊断和治疗方案选择有一定的指导意义。     

急性前壁心肌梗死时下壁导联ST段改变的临床价值

目的探讨急性前壁心肌梗死病人下壁导联ST段改变的临床价值.方法对93例冠状动脉左前降支(LAD)单支病变所致急性前壁心肌梗死病人,根据早期心电图下壁导联ST段改变将其分为压低组、抬高组、无改变组3组,与冠状动脉造影结果进行分析比较.结果下壁导联ST段压低组中71.4%为LAD非包绕型近端病变;抬高组中61.5%为LAD包绕型远端病变;无改变组中LAD包绕型近端病变和LAD非包绕型远端病变所占比例相近.结论急性前壁心肌梗死病人下壁导联ST段改变与LAD形态及病变部位有关.     

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.