急性心肌梗塞后左室重构变化的研究

应用二维多普勒超声心动图对６８例急性心肌梗塞（ＡＭＩ）患者的左室重构（ＬＶＲ）变化进行了观察。结果显示，心肌梗塞后ＬＶＲ早期（３～６周）左室舒张末内径（ＬＶＤｄ）、左室舒张末容积（ＥＤＶ）、左室收缩末容积（ＥＳＶ）、左室收缩期最大室壁应力（Ｅｄｂ）、左室收缩末期室壁应力（Ｅｓｂ）、平均室壁应力（ｍｅａｎｂ）、二尖瓣舒张晚期血流速度峰值（ＰＶＡ）、左房张力（ＬＡＴ）、左房射血力（ＬＡＦ）及峰值充盈速度（ＰＦＲ）显著增大（Ｐ＜０．０１－０．００１），射血分数（ＥＦ）、心输出量（ＣＯ）、左室收缩期圆周指数（ＬＶＳＣＩ）、平均周边纤维缩短速率（ＭＶＣＦ）、二尖瓣舒张早期血流速度峰值（ＰＶＥ）及ＰＶＡ／ＰＶＥ显著降低（Ｐ＜０．０１－０．００１）。ＬＶＲ晚期（６－１２个月），ＥＤＶ、ＥＳＶ增加，ＥＦ、ＣＯ及ＬＶＳＣＩ降低（Ｐ＜０．００１）；与ＬＶＲ早期比较，ＰＶＥ、ＰＶＡ及ＬＡＦ无显著性差异（Ｐ＞０．０５）。提示ＡＭＩ后ＬＶＲ的主要病因是梗塞区膨展、左室扩张、容量负荷及室壁应力增加，从而导致心肌梗塞并发症；ＥＳＶ、ＥＤＶ及ＥＦ可作为了解远期ＡＭＩ患者预后的最佳指标。     

急性下壁心肌梗死左前分支阻滞与冠脉病变的关系

目的 探讨下壁急性心肌梗死（ＡＭＩ）左前分支阻滞（ＬＡＨＢ）与冠脉病变的关系。方法 分析７１例下壁ＡＭＩ急性期病人的冠状动脉造影结果，比较出现或不出现ＬＡＨＢ患者间冠脉病变的差异。结果 ７１例患者中１３例（１８．３％）在ＡＭＩ急性期出现ＬＡＨＢ，与５８例不伴有ＬＡＨＢ的患者比较，前者左前降支狭窄的发生率及多支冠脉病变的发生率均明显较高（Ｐ〈０．０１），梗死相关动脉有更严重的残余狭窄（Ｐ〈０．０５）     

21例急性心肌梗互合并心房颤动的临床意义

目的：探讨急性心肌梗死（ＡＭＩ）合并心房颤动（Ａｆ）的临床意义。方法：观察相关指标，结果：ＡＭＩ合并Ａｆ２１例，其发生率为１９．４％，ＡＭＩ合并Ａｆ组与无Ａｆ组在年龄、心功能分级、梗死范围、严重并发症发生率及住院死亡率在显性差异（Ｐ〈０．０５），结论：Ａｆ是ＡＭＩ的常见并发症，是预后不良的指标。     

以QRS记分法比较心肌梗死延展和再梗死的面积及心衰,心脏性休？…

目的 探讨急性心肌梗死（ＡＭＩ）后，近期（４周一半年内）再次心肌梗死（再梗死ＲＩ）和梗死延展（ＩＥ）发生后二者梗死面积及心衰、心脏性休克发生率的差异。方法 对２３２例ＡＭＩ患者采用Ｗａｇｎｅｒ心电图记分法，选取ＡＭＩ充分发展期及ＲＩ和ＩＥ后的稳定期，进行ＱＲＳ记分。结果 ＩＥ和ＲＩ发生后ＡＲＳ记分值较两种病变发和匀〈０．０１。ＲＩ患者ＡＲＳ记分值多于ＩＥ患者，Ｐ〈０．０５。ＲＩ患者心衰及心脏性体克     

脉冲多普勒超声心动图对室性早搏时血液动力学定量研究

目的：探讨室性早搏对心脏排血和充盈的血液动力学变化的影响。方法：对４０例室性早搏（室性早搏组）的患者及３０例程控刺激（程控刺激组）诱发室性早搏的患者记录二尖瓣口及主动脉瓣口的血流频谱，分别测量室性早搏前正常心动周期二尖瓣口和主动脉瓣口的流速积分（ＮＭＶＩ和ＮＡＶＩ），室性早搏时二尖瓣口和主动脉瓣口的流速积分（ＥＭＶＩ和ＥＡＶＩ），及代偿心搏（室性早搏后）二尖瓣口和主动脉瓣口的流速积分（ＰＭＶＩ和ＰＡＶＩ）。结果：ＥＭＶＩ和ＥＡＶＩ明显低于ＮＭＶＩ和ＮＡＶＩ，ＰＭＶＩ和ＰＡＶＩ显著高于ＮＭＶＩ和ＮＡＶＩ，但仅代偿３６％和３８％。室性早搏提前指数Ｔ－Ｒ′／Ｒ－Ｒ与室性早搏排血比值（ＥＡＶＩ／ＮＡＶＩ）及室性早搏充盈比值（ＥＭＶＩ／ＮＭＶＩ）呈良好相关，当Ｔ－Ｒ′／Ｒ－Ｒ＜０．２２时，ＥＡＶＩ／ＮＡＶＩ降至０。即无血液排出。结论：室性早搏时心搏量和充盈量明显下降，室性早搏后的心搏量和充盈量增高，但代偿不足。当Ｔ－Ｒ′／Ｒ－Ｒ＜０．２２时，ＥＡＶＩ／ＮＡＶＩ降至０。过早的发生室性早搏时在临床工作中应予重视     

超声观察老年急性心肌梗塞后的进行性左室重构

目的观察老年急性心肌梗塞（ＡＭＩ）后进行性左室重构（ＰＬＶＲ）。方法４６例老年ＡＭＩ于入院时、出院前和ＡＭＩ后半年应用Ａｃｕｓｏｎ１２８或ＨＰ１５００型彩色多普勒超声检查。左室舒张末期容量指数（ＥＤＶＩ）每次增长＞８％者归为有ＡＭＩ后ＰＬＶＲ。结果９例有ＡＭＩ后ＰＬＶＲ者较３７例无ＡＭＩ后ＰＬＶＲ者心功能差（Ｐ＜０．０５）。在有ＡＭＩ后ＰＬＶＲ组ＡＭＩ并发症总例数较多（Ｐ＜０．０５）。结论老年人ＡＭＩ病例中心功能差者易发生ＡＭＩ后ＰＬＶＲ。ＡＭＩ并发症与ＡＭＩ后ＰＬＶＲ有关。     

急性心肌梗塞后左室重构的超声心动图随访研究

目的：应用超声心动图对９２例急性心肌梗塞（ＡＭＩ）患者的左室重构（ＬＶＲ）进行随访研究,以探讨ＬＶＲ衍变规律。方法：分别于ＬＶＲ早期（３～６周）及后期（６～１２个月）应用彩色多普勒血流显像仪测定左室舒张末内径（ＬＶＤｄ）、左室收缩期圆周指数（ＬＶＳＣＩ）、左室舒张末及收缩末容积（ＥＤＶ,ＥＳＶ）、射血分数（ＥＦ）、心输出量（ＣＯ）、室壁应力指数（Ｅｄｂ,Ｅｓｂ,ｍｅａｎ服ｂ）、平均周边纤维缩短速率（ＭＶＣＦ）、二尖瓣舒张早期及晚期血流速度峰值（ＰＶＥ,ＰＶＡ）、左房张力（ＬＡＴ）、左房射血为（ＬＡＦ）及峰值充盈速度（ＰＦＲ）进行分析。结果：ＡＭＩ后ＬＶＲ早期可出现ＬＶＤｄ、ＥＤＶ、ＥＳＶ、Ｅｄｂ、Ｅｓｂ、ｍｅａｎｂ、ＰＶＡ、ＰＶＡ／ＰＶＥ、ＬＡＴ、ＬＡＦ显著增大（Ｐ＜０．０１－０．００１）,ＰＦＲ、ＥＦ、ＣＯ、ＬＶＳＣＩ、ＭＶＣＦ、ＰＶＥ显著降低（Ｐ＜０．０１—０．００１）;后期上述在室功能指标进一步减退,左房增力泵失代偿,左室畸形增加。结论：ＡＭＩ后ＬＶＲ的主要原因是梗塞区膨展、左室扩张、容量负荷及室壁应力增加,从而导致二尖瓣返流等并发症的出现。ＥＳＶ、ＥＤＶ及ＥＦ可作为了解远期预后的最佳指标。     

老年急性心肌梗塞心率变异时域分析

目的分析急性心肌梗塞（ＡＭＩ）后老年患者心率变异（ＨＲＶ）时域指标，了解ＡＭＩ后ＨＲＶ变化。方法以多单位协作方式对１５７例ＡＭＩ后２周的老年患者行动态心电图检测ＨＲＶ时域法５项指标，并与健康老年组对比分析。数据经ＥｐｉＩｎｆｏ（６．０）统计软件处理。结果①ＡＭＩ患者的正常Ｒ－Ｒ间期标准差（ＳＤＮＮ）、平均值的标准差（ＳＤＡＮＮ）和标准差的平均值（ＳＤＮＮＩｎｄｅｘ）低于对照组（Ｐ＜０．０１），而相邻正常Ｒ－Ｒ间期差值的均方根（ＲＭＳＳＤ）和相邻正常Ｒ－Ｒ差值大于５０ｍｓ记数占总Ｒ－Ｒ间期数的百分比（ＰＮＮ５０）虽低于对照组，但无显著差异（Ｐ＞０．０５）。②ＡＭＩ后ＨＲＶ时域５项指标男、女性别间无显著性差异（Ｐ＞０．０５）。③ＳＤＮＮ、ＳＤＡＮＮ和ＳＤＮＮＩｎ－ｄｅｘ在心肌梗塞各部位间无显著差异（Ｐ＞０．０５），ＲＭＳＳＤ和ＰＮＮ５０前间壁低于下壁心肌梗塞（Ｐ＜０．０５）。结论老年人ＡＭＩ后ＨＲＶ降低。反映交感神经活性的ＳＤＮＮ、ＳＤＡＮＮ和ＳＤＮＮＩｎｄｅｘ和反映迷走神经活性的ＲＭＳＳＤ和ＰＮＮ５０２组指标变化不相同。     

老年人钙化性心脏瓣膜病六年随访

通过对９５例超声心动图检出的老年人钙化性心脏瓣膜病及９５例年龄、性别与其相匹配的无瓣膜钙化者的六年对照观察发现，瓣膜钙化组患者心前区杂音、心脏扩大、窦房结病变、传导障碍及房颤的发生率显著高于对照组（Ｐ＜０．０１），充血性心力衰竭、心肌梗塞、脑血管病及晕厥的发生率也高于对照组（Ｐ＜０．０５）。合并二尖瓣环钙化者的心前区杂音、心肌梗塞、充血性心力衰竭及心源性病死率均显著高于无二尖瓣环钙化者（Ｐ＜０．０５）。由于合并瓣膜钙化的患者窦房结病变及心脏传导阻滞发生率高，起搏器的植入率也明显高于对照组（Ｐ＜０．０５）。瓣膜钙化组的总病死率为１４．７％，其中心源性死亡占６４．３％，显著高于对照组的３．２％及３０．０％（Ｐ分别＜０．０１及０．０５）。     

溶栓治疗老年人急性心肌梗死34例分析

目的观察老年人急性心肌梗死（ＡＭＩ）溶栓治疗的安全性和有效性。方法７１例７０岁以上老年ＡＭＩ患者分成溶栓组（３４例）和对照组（３７例），比较其临床结果。结果（１）梗死相关动脉（ＩＲＡ）的再通率溶栓组显著高于对照组（６１．８％及１３．５％，Ｐ＜０．０１）；（２）溶栓明显改善了老年ＡＭＩ患者的左室射血分数（６３％及５２％，Ｐ＜０．０５）；（３）溶栓显著降低了老年ＡＭＩ患者的住院病死率（３５．１％对１４．７％，Ｐ＜０．０５），降幅为２０．４％；（４）溶栓组发生出血并发症６例（皮肤淤斑４例，上消化道出血２例），无严重出血（无需输血）并发症及脑卒中发生。结论对无禁忌证的老年人ＡＭＩ进行溶栓治疗，可以增加其血管再通率、改善心功能及降低病死率。     

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.     

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.     

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.