心尖肥厚型心肌病18例临床分析

目的:对心尖肥厚型心肌病辅助检查进行分析,探讨其临床诊断价值。方法:以心电图、超声心动图、磁共振、冠状动脉造影及左室造影等检查方法检测18例心尖肥厚型心肌病。结果:18例心电图显示胸前导联T波倒置呈TV4>TV5>TV3,R波振幅增高以RV4>RV3> RV5;超声心动图左室心尖室壁舒张期厚度(17.22±14.20mm)与心室间隔基底段厚度(1.07±0.23mm)之比为1.60±0.16;4例冠状动脉造影检查后排除冠心病;6例因超声心动图不典型而行磁共振心脏成像检查后确诊。结论:标准12导联心电图显示胸前导联T波倒置伴R波增高应高度怀疑心尖肥厚型心肌病,可进一步行超声心动图或磁共振检查确诊。     

心尖肥厚型心肌病13例诊断及误诊分析

目的讨论通过心电图、超声心动图及左室造影等检查诊断心尖肥厚型心肌病(AHCM)的可行性以及分析误诊原因。方法对13例AHCM病例的心电图、超声心动图、及左室造影结果进行分析。结果AHCM合并有心电图异常者13例(100%)其中有12例心电图有特征性改变;心超提示心尖区增厚者11例;左室造影提示舒张期黑桃A样改变的5例;有7例初诊误诊为冠心病。结论AHCM较易被误诊为冠心病,心电图、超声心动图、左室造影、MRI检查对于AHCM的早期诊断与鉴别诊断有重要意义。     

非典型心尖肥厚型心肌病的心电图及超声心动图表现

目的 :探讨 11例仅心电图异常 T波改变 ,而按冠心病诊治无效患者的病因 ,并评价其预后。　　方法 :对 11例非典型心尖肥厚型心肌病患者 (男 6例、女 5例 )进行心电图、核素心肌断层、踏车运动试验、2 4小时动态心电图、超声影像等检查 ,并与正常人配对比较。　　结果 :11例患者心尖室壁肥厚 ,其舒张期厚度 (平均 1.42± 0 .2 3 cm ) ,与心室间隔基底段舒张期厚度 (1.0 7± 0 .0 7cm )之比为 1.45± 0 .16 ,心尖肥厚组心尖室壁舒张期厚度与正常对照组 (1.0 3± 0 .11cm)比较其差异非常显著 (P<0 .0 1) ,各心腔大小、左心室后壁、左心室收缩及舒张功能正常 ;心电图除 T波异常外无其它异常表现 ,其他各项检查均正常。　　结论 :非典型心尖肥厚型心肌病患者 ,特别是早期病变无特异性临床表现时 ,易漏诊和误治 ,常规测量心尖室壁厚度可指导早期诊断和治疗。     

左心室心尖部室壁增厚特征与心电图T波倒置关系分析

目的:探讨左心室心尖部室壁增厚且心电图胸前导联出现无法解释的广泛T波倒置患者的室壁增厚特征与心电图T波倒置的关系。方法:连续入选91例超声心动图提示左心室心尖部室壁增厚且心电图胸前导联广泛T波倒置的患者,包括53例典型心尖肥厚型心肌病(AHCM)患者(典型AHCM组)、25例早期AHCM患者(早期AHCM组)、13例可疑AHCM患者(可疑AHCM组)。在典型AHCM组与早期AHCM组中共有单纯型29例,混合型49例。测量各导联T波倒置的深度(T)及T波倒置的最大深度(Tmax),测量心尖部各室壁厚度及最大厚度(APWTmax)并计算其与左心室后壁厚度的比值(ABR)。结果:各组间心电图上T波倒置的导联分布、最大深度及胸前导联T波倒置的深度之和比较差异无统计学意义。在78例典型和早期AHCM患者中,心尖厚度与T波深度无明显相关性,但在其中的29例单纯型患者中,APWT max分别与TV_5(r=0.381)及Tmax(r=0.416)弱相关;而在49例混合型及13例可疑AHCM患者中心尖厚度与T波深度也无明显相关。结论:在左心室心尖肥厚程度与T波深度关系上,只有单纯型AHCM患者的APWTmax与T波深度弱相关,而在混合型AHCM患者中二者无明显相关性。     

心尖肥厚型心肌病患者心电图的诊断意义

目的探讨心尖肥厚型心肌病患者的心电图特征性改变及临床诊断意义。方法分析38例心尖肥厚型心肌病患者的心电图及超声心动图资料。结果心尖肥厚型心肌病合并有心电图异常和超声心动图异常改变者38例(100%),其中伴胸前导联巨大倒置T波≥0.2mV～0.3mV,以V3～V4最明显29例(76%);左胸V4～V6导联R波电压增高,且RV4>RV5>RV6者26例(68.4%);ST段压低,以V3～V4最明显者29例(76%);超声心动图示心尖部肥厚达15mm或以上伴心尖部心腔狭小者38例。结论心电图对心尖肥厚型心肌病具有早期诊断价值和预测意义。     

心尖肥厚型心肌病的心电图对比观察

目的　观察心尖肥厚型心肌病 (AHCM )与其他类型的肥厚型心肌病 (HCM )的心电图改变。方法　对 87例HCM(B组 )者行彩色多普勒超声心动图 (UCG)及心电图检测 ,对比 1 6例AHCM组 (A组 )与 71例HCM组 (B组 )的心电图ST段压低、T波倒置、传导阻滞、病理性Q波、左室高电压、WPW的发生率。结果　A组与B组的病理性Q波、巨大倒置T波的发生率存在显著性差异 (P <0 0 5 )。结论　A、B组两组之间虽然心电图及其它方面存在许多共性 ,但病理性Q波以及巨大倒置T波的存在与否 ,对两种HCM的心电图改变有鉴别诊断价值。     

胸导联心电图R-ST-T变化对心尖肥厚型心肌病的诊断价值

目的探讨胸导联心电图R-ST-T变化与心尖肥厚型心肌病(AHCM)的关系.方法对经超声心动图和/或左心室造影确诊的42例AHCM病人(AHCM组)及35例非AHCM病人(对照组)的心电图进行对比分析,分析胸导联心电图R-ST-T变化(R波增高呈RV4＞RV5＞RV3,T波倒置呈TV4＞TV5＞TV3,ST段下移,且均无动态演变)对判断AHCM的临床价值.结果 AHCM组心电图出现异常42例(100%).胸导联心电图R-ST-T变化在AHCM的出现率为78.6%,显著高于对照组的8.6%(P＜0.01).胸导联心电图R-ST-T变化预测AHCM的敏感度为78.6%、特异度为91.4%.5例AHCM病人胸导联心电图R-ST-T变化早于超声心动图及左心室造影改变.结论胸导联心电图R-ST-T变化是诊断AHCM的敏感、特异的预测指标,心电图对AHCM的诊断具有早期预测意义.     

心尖肥厚型心肌病的临床诊断(附13例临床报告)

目的：探讨心尖肥厚型心肌病的心电及影像学检查的特点及临床诊断价值。方法：对13例心尖肥厚型心肌病的心电图、超声心动图、放射核素心肌断层显像、冠状动脉造影及左室造影、磁共振成像等检查方法进行分析总结。结果：心电图的典型改变是胸前导联巨大倒置的T波伴ST段下降和QRS波群高血压,以V4导联最为显。超声心动图示心尖部肥厚,心尖部心室腔狭小甚至闭塞。磁共振成像清晰显示心尖部心肌肥厚。心室造影左心室舒张末期呈“黑桃”样改变,但部分呈“非黑桃”样改变。结论：心电图胸前导联巨大倒置T波TV4＞TV5伴QRS波群高血压RV4＞RV5是诊断AHCM的重要线索。超声心动图是诊断AHCM的重要手段。磁共振成像对确诊该病最有价值。心血管造影及放射性核素心肌显像是AHCM的鉴别诊断手段但不是必备检查。     

心尖肥厚型心肌病超声诊断特点及随访

目的 探讨心尖肥厚型心肌病超声诊断特点及预后随访.方法 对27例心尖肥厚型心肌病患者心电图、超声心动图进行1～13年(平均5.2年)随访观察.结果 27例患者心电图胸前导联异常T波深置,V_(3-5)导联最为显著,重者出现巨大倒置T波≥10 mm,胸前导联R波振幅V_4>V_5>V_3,超声心动图显示心尖部明显增厚15～37(18.0±3.3)mm,末次随访心尖部厚度(19.7 ±3.7)mm,左室心尖部厚度与左室后壁厚度比值分别为1.7±0.3和1.9±0.9,随访前后比较差异有统计学意义(P<0.05),但左室舒张末期内径及左室射血分数随访前后未见显著差异.主要心血管事件为心房颤动,心功能Ⅲ～Ⅳ级,前壁心肌梗死及心脏猝死.结论 心尖肥厚型心肌病主要依据心电图胸前导联T波深置及超声心动图心尖肥厚特点作出诊断,该病进展缓慢,一般临床预后较好.     

心电图对肥厚型心肌病的诊断价值

目的通过回顾分析心尖肥厚型心肌病(AHCM)患者的12导联心电图特点,探讨其对AHCM的诊断指导价值。方法对2014年12月~2016年12月于河南省安阳地区医院心内科就诊的60例AHCM患者作为观察组,与同时期我院正常体检人群50名为对照组。行12导联心电图,进行回顾性分析,比较两组人群的心电图变化情况及有无特征性变化等。结果观察组患者心电图表现为胸导联T波倒置伴ST段下移及左室高电压表现;胸导联QRS波群时间延长,且QRS波群振幅在不同导联上变化明显,均超过正常值;在ST段分别表现为V3~V6和Ⅱ、Ⅲ、a VF下移;且有42例出现V3~V6 T波倒置。患者左胸导联R波电压增高,ST段压低,0.05m V,T波对称性倒置,左胸导联同导联R波高度与T波倒置深度,ST段压低深度呈负相关(P0.05),T波倒置深度与ST段压低深度呈正相关(P均0.01)。结论心电图诊断对心尖肥厚型心肌病有辅助指导价值,对AHCM患者早期行心电图检查可提高其疾病确诊率。     

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.     

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.