美乐心治疗充血性心力衰竭43例临床观察

近来，我们采用静滴美乐心治疗充血性心力衰竭患者４３例，取得了满意的疗效。现报告如下。 一般资料：经病史、查体、超声心动图等检查诊断充血性心力衰竭患者４３例。男２９例，女１４例，年龄３１～７８岁，平均４６．３±９．４岁。其中缺血性心脏病１９例．高血压性心脏病１５例，扩张型心肌病６例，风湿性心脏病３例。窦性心律１０例，心房纤颤１１例，房性期前收缩５例，室性期前收缩８例，左束文传导阻滞２例，Ⅰ度房室传导阻滞２例，Ⅱ度Ⅰ型房室传导阻滞３例，Ⅱ度Ⅱ型房室传导阻滞１例，Ⅲ度房室传导阻滞１例。心功能分级（ＮＹ…     

严重充血性心力衰竭患者QT离散度与心脏性猝死关系的研究（摘要）

严重充血性心力衰竭患者ＱＴ离散度与心脏性猝死关系的研究（摘要）彭应心阮汉权张德兰杨素洁王杏梅严重充血性心力衰竭（ＣＨＦ）预后不佳，其死亡原因的３０～５０％为心脏性猝死（ＳＣＤ）。本研究通过对ＣＨＦ患者心电图ＱＴ间期离散度（ＱＴｄ）与ＪＴ间期离散度（Ｊ...     

老年冠心病患者Q-Tcd和J-Tcd的观察

目的；探讨老年冠心病患者及其亚组的Q－TC和J－TC离散度（Q－Tcd和J－Tcd）。方法：测量60例老年冠心病患者和60例无冠心病老年人心电图的R－R、Q－T、QRS和J－T（J－T=Q－T-QRS）间期，根据测量结果计算Q－Tcd和J－Tcd。结果：老年冠心病患者的平均Q-Tcd和J－Tcd均显著大于年龄相仿的无冠心病老年人（P＜0．001）。老年冠心病亚组中A组的平均Q－Tcd和J－Tcd显著小于B组（P＜0．02）和C组（P＜0．005、P＜0．01）。结论：本组结果提示Q－Tcd、J－Tcd可预示冠心病严重程度，作为预测冠心病预后的良好指标。     

慢性充血性心力衰竭患者的QT离散度探讨

探讨ＱＴ间期离散度（ＱＴｄ）在慢性充血性心力衰竭（ＣＨＦ）患者中对猝死的预测及与临床心功能间的关系。材料与方法随机选择连续临床ＣＨＦ患者２６例。男１７例，女９例，平均年龄５０９岁（１０～７４岁）。按ＮＹＨＡ心功能分级，Ⅱ级９例，Ⅲ级８例，Ⅳ级９例。...     

急性冠状动脉综合征心电图改变的临床意义

目的 探讨急性冠状动脉综合征心电图改变的临床意义。方法 对104例接受经皮穿刺腔内冠状动脉成形术加支架植入术的急性冠状动脉综合征患者（Ⅰ组Q波心肌梗死54例、Ⅱ组非Q波心肌梗死12例和Ⅲ组不稳定心绞痛38例）的冠状动脉病变和心电图改变进行分析。结果 冠状动脉完全闭塞Ⅰ组占75．55％，Ⅱ组占33．33％，差异有显著性意义（P＜0．05）。Ⅲ组无冠状动脉完全闭塞。3例冠状动脉多支病变差异无显著性意义（P＞0．05）。Ⅰ组：前壁心肌梗死多于下壁（32／54：22／54），发生持续性窦性心动过速、三度房室传导阻滞、室性心律失常、死亡率高。Ⅱ组：广泛持续性ST－T改变或以T波深倒置演变特征或Q波迅速消失，ST－T动态改变。Ⅲ组：胸痛发作时ST－T改变或伪性改善，不发作时ST－T正常或仍有改变。结论 急性冠状动脉综合征心电图表现有多种形式。无Q波心肌梗死并不少见。心电图的易变性是急性冠状动脉综合征的特征之一。     

Ⅰ、Ⅱ度房室传导阻滞与QT离散度在扩张型心肌病患者预后判断中的对照研究

分析70例扩张型心肌病（DCM）患者P－R间期和QT离散度（QTd）变化，并与72例正常人对照。结果：DCM组P-R间期（不包括Ⅱ度房室传导阻滞—AVB）和QTd较对照组显著增高（P＜0．01）。1个月内心脏性猝死（SCD）者QTd较存活者和进行性心力衰竭死亡者显著增高（P＜0．01）。Ⅰ度和Ⅱ度AVB者SCD发生率显著高于P－R间期正常者（P＜0．05）。QTd＞110ms者SCD发生率显著高于QTd≤110ms者。QTd＞110ms同时伴Ⅰ度或Ⅱ度AVB者全部发生SCD。提示：DCM患者SCD的发生主要与QTd有关；Ⅰ度、Ⅱ度AVB是DCM患者SCD的危险因素。     

硝酸甘油静脉滴注对充血性心力衰竭患者血浆内皮素浓度的影响

目的：评价硝酸甘油（ＮＧ）对充血性心力衰竭患者血浆内皮素的影响。方法：应用放射免疫法测定３２例充血性心力衰竭患者和１７例健康人血浆内皮素浓度。充血性心力衰竭组含１７例冠心病和１５例非冠心病患者。观测ＮＧ静脉滴注前后内皮素、心率和血压的动态变化。结果：充血性心力衰竭组内皮素浓度为９３．８６±１３．４８ｐｇ／ｍｌ，较对照组（３８．１７±１７．２４ｐｇ／ｍｌ）显著升高（Ｐ＜０．００１）。内皮素升高的程度与充血性心力衰竭的严重程度平行；与充血性心力衰竭的病因无关。ＮＧ静脉滴注后充血性心力衰竭患者内皮素浓度（６６．１８±１１．１３ｐｇ／ｍｌ）显著降低（Ｐ＜０．００１）；心功能Ⅱ级、Ⅲ级、Ⅳ级者分别降低２６％、２９％、３４％。血压和心率无明显变化。结论：ＮＧ不仅能改善充血性心力衰竭患者血液动力学紊乱，而且能显著降低内皮素的血浆浓度。     

继发性长Q—T间期致尖端扭转型室性心动过速1例

患者男性,88岁。3个月前动态心电图诊断为完全性右束支传导阻滞,二度（2：1）房室传导阻滞。此次突发晕厥再次行动态心电图检查（图1A）示：三度房室传导阻滞,缓慢心率35次／分,房室交接区逸搏心律伴完全性右束支传导阻滞,Q—T间期长达0．70s。动态心电图全程记录反复发作的多形性室性心动过速,长Q—T间期诱发尖端扭转型室性心动过速。最长持续时间29s伴短暂阿斯发作,自行终止（图1B）。次日患者发作频率增多,紧急安装临时心脏起搏器,未见阿斯发作,第三天改为永久性VVI心脏起搏器（图略）。     

心房激动超低电位一例

患者男性,26岁,临床诊断为充血性心肌病,心衰Ⅲ度。 心电图分析:图A示体表心电图标准导联和V_(1、3、5)六个导联。各导联均未见P波,R—R规则,QRS波时限0.13s,Ⅰ呈Rs型,Ⅲ呈rS型,V_1呈rsR型,Q—T间期0.36s,心电轴-60°。Ⅰ、V_3、V_5的QRS似有“病Q”。图B示食管导联心电图,见规则正负双向P波,频率97次/分,与图A心室率相等,1:1下传,P—R间期0.14s,Q—T间期亦为0.36s。 心电图诊断:窦性心律,心房激动超低电位,QRS低电压,完全性右束支传导阻滞伴左前分支传导阻滞,病理性Q波。     

冠装动脉移植术患者Q—T离散度与心律失常的关系分析

目的 探讨冠状动脉移植术对Q－T离散度（Q－Td）的影响及Q－Td与术后心律失常的关系。方法 对87例冠状动脉移植术患者（分成Ⅰ组65例：术后无心律失常;Ⅱ组12例：术后伴室性心律失常;Ⅲ组10例：术后伴房性心律失常）术前术后Q－T离散度进行分析。结果 3组Q－Tmax、Q-Tcd、Q－Td在术前、术后3天差异均有显著性意义（P均＜0.05）。在术前,术后3天、1周,室性心律失常组Q－Td均高于下学,而无心律失常组和房性心律失常组基本正常。术后2周室性心律失常组Q－Td也已降至正常,此时3组的Q－Td与术前相比差异均有显著性意义（P＜0.05）。Q－Td和ST－T改变呈显著正相关（P＜0.05）,且与室笥心律失常的发生呈非常显著正相关（P＜0.01）。结论 Q－Td一定程度上反映心肌缺血的程度,可作为冠状动脉移植术后心肌血供改善的一个指标。Q－Td增大对心律失常及猝死有一定预测作用。     

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.