射频消融治疗儿童室上性心动过速

目的 :探讨射频消融 （RFCA）在治疗儿童室上性心动过速 （SVT）中的应用价值。方法 :回顾分析唐都院近 5年接受 RFCA治疗的 4 9例患儿的疗效。结果 :房室折返性心动过速 （AVRT） 38例 ,占 77.6 % ;其中左侧房室旁路2 9例 ,右侧房室旁路 9例 ,房室结折返性心动过速 （AVNRT） 11例 ,占 2 2 .4 %。全部消融成功。术后无 1例复发 ,亦无严重并发症。结论 ;AVRT和 AVNRT是儿童 SVT中最常见类型 ;RFCA是治疗儿童 SVT安全、有效的方法     

左心室刺激在射频消融左侧房室旁路中的价值

目的室房传导的不完全阻断可能会导致房室折返性心动过速复发.鉴于心脏的解剖关系和电生理特点,推测左心室内刺激对于判定经左侧旁路的室房传导是否被彻底阻断要优于传统的右心室刺激.方法213例左侧旁路参与的顺向型房室折返性心动过速患者(男性125例),平均年龄(38±19)岁.在射频消融前、后均进行右心室心尖部S1S2程序刺激及S1S1分级递增刺激;射频消融后,在右心室刺激显示经旁路的室房逆传完全被阻断后,经大头消融电极在左心室游离壁进行S1S1和S1S2刺激.结果在常规右心室刺激显示经旁路的室房传导被阻断之后,共有6例患者在经大头电极以相同的条件在左心室刺激时显示经旁路的室房传导仍然存在.其中1例术前有心室预激,消融后预激已消失而室房传导仍存在,有2例仍能诱发出房室折返性心动过速.另l例既往接受消融后复发的病例在此次消融前即见到此现象.7例患者均接受射频消融,直至右心室心尖部和左心室刺激均无经旁路的室房传导.平均随访(18±9)个月,均无预激或房室折返性心动过速复发.结论在对左侧旁路参与的顺向型房室折返性心动过速进行射频消融治疗时,左心室刺激可以作为判定经左侧旁路的室房传导是否被完全阻断的电生理检查手段,这可能有助于减少左侧旁路射频消融之后房室折返性心动过速的复发机会.     

预激综合征与房室反复性心动过速

预激综合征伴发的室上阵发性心动过速(PS-VT)与折返原理有关。其折返环路多位于房室之间,既包括心房,也包括心室。因此,称之为房室反复(折返)性心动过速(AVRT)为宜。一、AVRT分型及发生机理按房室旁路的部位和预激的方向,AVRT可分为以下类型: 1.顺向型:是指房室交界区呈顺向传导,房室旁路呈逆向传导的AVRT。其折返环路为:心房→房室交界区→心室→房室旁路→心房。据电生理研究,房室旁路不存在递减性传导,其顺向性传导速度较快,有效不应期较长。反之,房室结呈递减     

Swartz鞘在阵发性室上性心动过速常规射频消融失败病例中使用方法探讨

目的 对47例阵发性室上性心动过速(PSVT)用常规电生理标测和导管射频消融(RFCA)未成功者改用Swartz鞘作为支撑，探讨Swartz鞘在提高PSVT消融成功率中作用。方法右房房性心动过速(AT)和房室结折返性心动过速(AVNRT)慢径路消融用SRoSwartz鞘，左侧房室旁路(AP)并房室折返性心动过速(AVRT)穿房阿隔后用SL，鞘，右侧AP据不同部位用SR4、SR2、SR3鞘。结果47例PSVT常规方法消融未成功者其中46例改用Swartz鞘作支撑后获得成功。结论 Swartz鞘的使用明显提高PSVT患者RFCA的成功率。     

房室旁道和房室结双径引起的折返性心动过速初次发病年龄和因素分析

探讨房室旁道 (简称房道 )和房室结双径引起的折返性心动过速的初次发病年龄。 15 5例旁道和房室结双径引起的折返性心动过速中 ,房室折返性心动过速 (AVRT) 10 6例、房室结折返性心动过速 (AVNRT) 4 9例。根据年龄和心动过速病程推算初次发病年龄 ,然后比较AVRT和AVNRT、左和右侧旁道并AVRT、显性和隐匿性旁道并AVRT、男性和女性心动过速患者的初发年龄。结果 :AVRT和AVNRT的初发年龄分别为 2 9.9± 12 .85岁和 32 .33±11.84岁 ,组间比较无显著性差异。左、右侧旁道并AVRT、显性和隐匿性AP并AVRT、男性和女性心动过速患者初发年龄比较差异均无显著性 ,均是 30岁左右。结论 :30岁左右是AVRT和AVNRT初次发病的高发年龄段 ,其他年龄段呈散在发病     

射频消融术治疗室上性心动过速80例体会

用射频消融术治疗室上性心动过速80例.其中,房室折返性心动过速64例(65条旁路),56条左侧旁路中52条(92.9%)和9条右侧旁路中7条(77.8%)被阻断.14例房室结折返性心动过速(消融慢径)及2例房性心动过速和心房纤颤(消融房室结)均成功.比较初期30例和以后34例房室旁路病人的消融,显示了射频消融术开展过程中的学习曲线.此外,本文对预激综合征体表心电图旁路定位误差的原因,作了初步探讨.     

食管心电图辅助的心腔单导管消融房室旁路的方法学和临床意义

目的　 Kuck等提出的单导管消融房室旁路 (旁路 )的技术因缺乏心房电图而不适合隐匿旁路消融 ,也难以完整评价显性旁路消融的效果。本组报道经食管心电图 (TEE)辅助的心腔单导管法消融旁路的临床意义。　方法　 2 8例患者中显性旁路 1 3例 (左侧 9例 ,右侧 4例 ) ,隐匿性旁路 1 5例 (左侧1 3例 ,右侧 2例 )。同步记录心电图、TEE和消融电极局部电图。显性旁路在窦性心律标测和消融 ,隐匿性旁路诱发顺向型房室折返性心动过速 (AVRT)时标测和消融。消融导管刺激心室观察 TEE房波评价消融疗效。　结果　 2 8例均为单旁路参与的 AVRT,单导管消融成功 2 6例 (92 .9% )。左侧旁路消融的手术时间和 X线透视时间分别为 (2 5± 8) min和 (3 .9± 1 .3 ) min,右侧旁路消融则分别为 (3 4.2± 6.1 )min和 (1 0 .1± 5.1 ) min。　结论　 TEE辅助的心腔内单导管消融法可有效阻断旁路和评价消融效果 ,是一种在熟练掌握常规消融技术的基础上可采用的消融方法。     

射频消蚀房室旁路治疗预激综合症

17例预激综合症共17条房室旁路(其中左侧12条、右侧5条)行射频消蚀术。2例并有房室结双径路。12例左侧分路和1例右侧旁路消蚀成功(成功率77％)。1例随访6个月时心动过速复发(1／13)。第二次消蚀后出现3°房室阻滞。射频消蚀旁路是治疗房室折返性心动过速的有效方法．今后应加强对右侧旁路消蚀的研究。     

左束支阻滞时左侧房室旁路逆传的房室折返性心动过速周长变化

游离壁房室旁路同侧的束支阻滞时，常常使顺向型房室折返性心动过速(atrioventricular reentrant tachycardia，AVRT)的周长增加≥35ms。本文报道一例左侧游离壁房室旁路患者，左束支阻滞时AVRT的周长反而明显缩短。     

穿房间隔途径左侧游离壁旁路消融致心包填塞原因分析

目的:分析穿房间隔途径左侧游离壁旁路消融致心包填塞的发生率及可能原因。方法:分析2014年1月～2018年12月3个中等手术量电生理中心的1 332例室上性心动过速患者,其中男性723例,女性609例,中位年龄52 (35～61)岁。经电生理检查证实为房室结双径路折返性心动过速、左侧旁路参与的房室折返性心动过速或右侧旁路参与的房室折返性心动过速,然后再行房室旁路或者房室结双径路消融。分析左侧旁路参与的房室折返性心动过速患者,经主动脉逆行途径或者穿房间隔途径消融左侧旁路消融过程中心包填塞发生情况及可能原因。结果:1 332例患者接受1 440次射频消融术。左侧旁路参与的房室折返性心动过速453(34%)例,其中经主动脉逆行140例(31%)和穿房间隔途径313例(69%)。穿房间隔途径心包填塞发生3例(0.9%),靶点位置在左侧游离壁或左前游离壁。经心包穿刺引流后心包填塞症状缓解,无外科开胸修补发生。结论:左侧旁路射频消融相关的心包填塞发生率相对较低,原因可能与过度消融、机械操作损伤和误消融毗邻结构相关。     

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.     

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.