老年健康人及反流性食管炎患者食管运动功能的测定

目的比较老年和非老年健康人、反流性食管炎患者食管运动功能的异同。方法应用微气囊法对３０例老年健康人、１９７例非老年健康人、３０例老年反流性食管炎患者、４５例非老年反流性食管炎患者食管运动功能进行检测。结果（１）老年健康人食管下括约肌（ＬＥＳ）松弛时间为（８．１±０．８）秒,长于非老年健康人的（７．１±１．０）秒（Ｐ＜０．０１）,食管蠕动波压力和食管上括约肌压力〔（４０．５±２．９）ｍｍＨｇ和（４８．７±１８．１）ｍｍＨｇ,１ｍｍＨｇ＝０．１３３ｋＰａ〕低于非老年健康人的（４５．０±１０．５）ｍｍＨｇ和（５６．１±２１．２）ｍｍＨｇ（Ｐ＜０．０１）,同步收缩波发生率较非老年健康人增多（Ｐ＜０．０１）;（２）老年反流性食管炎组ＬＥＳ松弛时间〔（１０．８±１．１）秒〕延长和食管蠕动波压力〔（３３．２±２．９）ｍｍＨｇ〕降低比非老年组〔（９．２±３．７）秒、（４０．３±６．３）ｍｍＨｇ〕更明显（均为Ｐ＜０．０１）。结论（１）老年健康人有食管运动功能障碍;（２）老年反流性食管炎患者食管运动障碍比非老年患者明显。     

老年胃酸分泌与生长抑素的研究

目的探讨老年胃泌酸功能与生长抑素的调节机制．方法我室应用ＲＩＡ法对２０例老年人和１５例青年人胃液及９只Ｗｉｓｔａｒ老年鼠，２０只青年鼠胃粘膜组织、血浆生长抑素含量进行测定，以及对老年人和青年人进行胃酸分泌试验．结果老年人组比青年组胃液生长抑素呈高水平分泌，空腹胃液ＳＳ为（１３６５±４４３）ｎｇ／Ｌｖｓ（８５９±３４５）ｎｇ／Ｌ，Ｐ＜００１；刺激后ＳＳ为（１９６７±６６４）ｎｇ／Ｌｖｓ（１１４１±１０７３）ｎｇ／Ｌ，Ｐ＜００１．老年人比青年人胃酸分泌量明显减少，ＢＡＯ为（３５±２１）ｍｍｏｌ／ｈｖｓ（６９±４４）ｍｍｏｌ／ｈ，Ｐ＜００１；ＰＡＯ为（１３６±６４）ｍｍｏｌ／ｈｖｓ（２０８±１１２）ｍｍｏｌ／ｈ，Ｐ＜００５．不同年龄Ｗｉｓｔａｒ大鼠胃粘膜组织生长抑素具有不同的生理浓度，在老龄鼠比青年鼠ＳＳ也呈高水平分布，为（４５２５±１８４２）ｎｇ／ｇ蛋白ｖｓ（１５０９±９３８）ｎｇ／ｇ蛋白，Ｐ＜００１．结论老年胃泌酸功能改变与生长抑素调节作用存在重要关系．     

肝硬变血浆内毒素与一氧化氮水平的改变及关系的研究

目的研究肝硬变患者血浆内毒素与一氧化氮水平改变及关系．方法应用鲎试剂定量法和高效液相色谱分析法分别检测肝硬变患者４４例（男３２例，女１２例；年龄２５岁～７３岁，平均５０４岁±１１０岁）；ＣｈｉｌｄＰｕｇｈＡ级９例，Ｂ级２０例，Ｃ级１５例；其中有腹水者２７例及健康对照２５例（男１８例，女７例，年龄２４岁～６３岁，平均４６８岁±１２４岁）血浆内毒素和一氧化氮水平．结果肝硬变血浆内毒素及一氧化氮水平（２３７１ＥＵ／Ｌ±８２３ＥＵ／Ｌ，３８７１７ｎｇ／ｍｌ±１０６４１ｎｇ／ｍｌ）明显高于对照组（１５６７ＥＵ／Ｌ±２４６ＥＵ／Ｌ，２９２３０ｎｇ／ｍｌ±５４４９ｎｇ／ｍｌ，Ｐ＜００１）．腹水患者内毒素与一氧化氮水平（２３６９ＥＵ／Ｌ±５３６ＥＵ／Ｌ，４１４６７ｎｇ／ｍｌ±１０７０５ｎｇ／ｍｌ）明显高于无腹水者（１９６９ＥＵ／Ｌ±４５２ＥＵ／Ｌ，３２７１７ｎｇ／ｍｌ±７０２０ｎｇ／ｍｌ，Ｐ＜００５，Ｐ＜００１）．一氧化氮与内毒素呈直线正相关（Ｐ＜００１，ｒ＝０７８２）．结论肝硬变患者血浆内毒素及一氧化氮水平皆升高，且两者呈直线正相关．     

梗阻性黄疸内毒素血症与细胞免疫功能的关系

目的研究梗阻性黄疸免疫功能及其与内毒素血症的相关性．方法检测２８例梗阻性黄疸患者及２０例健康对照者血清内毒素，Ｔ淋巴细胞亚群及血清ＳＩＬ２Ｒ的水平．结果梗阻性黄疸患者血清内毒素和ＳＩＬ２Ｒ水平较对照组明显升高（４７０ｎｇ／Ｌ±１１３ｎｇ／Ｌ和７２５ｋＵ／Ｌ±２０１ｋＵ／Ｌｖｓ２８４ｎｇ／Ｌ±１０３ｎｇ／Ｌ和３２４ｋＵ／Ｌ±１１６ｋＵ／Ｌ，Ｐ＜００１），Ｔ淋巴细胞亚群ＣＤ３，ＣＤ４，ＣＤ４／ＣＤ８明显降低（５０４％±３３％和２９９％±３８％ｖｓ６３８％±４４％和３８３％±２８％，Ｐ＜００１；１２２±０３２ｖｓ１４３±０３７，Ｐ＜００５），同时亦发现梗阻性黄疸内毒素血症组较非内毒素血症组ＣＤ３，ＣＤ４水平明显减低，ＳＩＬ２Ｒ水平明显升高（４７４％±５１％和２７６％±５２％和８６７ｋＵ／Ｌ±２３１ｋＵ／Ｌｖｓ５２３％±５２％和３１２％±４３％和６７４ｋＵ／Ｌ±１８９ｋＵ／Ｌ，Ｐ＜００５）．相关分析显示血清内毒素水平与血清ＳＩＬ２Ｒ水平呈显著正相关（ｒ＝０８５１７，Ｐ＜００１）．结论梗阻性黄疸时内毒素血症与免疫功能状态密切相关．     

电针对狗胃粘膜血流量的影响及与血浆胃肠激素的关系

目的观察电针对狗胃粘膜血流量、血浆胃肠激素水平的影响及两者间变化的关系，以探讨电针对胃粘膜保护作用机制．方法将２０条狗随机分为４组，即：空白对照组，非经非穴组，上巨虚组，足三里组（每组５条）．采用激光多普勒血流仪测定狗胃粘膜血流量．用ＲＩＡ法同步测定血浆促胃液素（ＧＴ），生长抑素（ＳＳ），内皮素（ＥＴ）含量，用生化法测定一氧化氮（ＮＯ）含量，分析其电针前后的变化，并观察变化规律．结果电针后足三里组胃粘膜血流量显著升高（Ｖ，４６±０７→６９±１１，Ｐ＜００１），其他组无显著变化．电针后足三里组血浆ＧＴ，ＮＯ含量也显著升高（ｎｇ／Ｌ，６５±１２→１０２±２１，Ｐ＜００１），而ＳＳ，ＥＴ含量显著下降（ｎｇ／Ｌ，２３１±１８→１９４±２７，Ｐ＜００５；９７８±１７９→５５８±１５３，Ｐ＜００５）；上巨虚组ＮＯ含量显著上升，ＥＴ显著下降（Ｐ＜００５），但足三里组的变化趋势更明显．空白对照组，非经非穴组则无显著变化．结论电针足三里穴可使狗胃粘膜血流量增加，与通过影响胃粘膜血流量的某些活性物质的含量改变有关，并具有一定的穴位特异性．     

胃肠激素在肝硬变胃粘膜病变发病机制中的作用

目的探讨胃肠激素（ＧＩＨ）在肝硬变胃粘膜病变发病机制中的意义．方法用ＲＩＡ法测定临床诊断为肝硬变伴胃粘膜病变（ＣＧＭＬ）１７例，肝硬变（ＬＣ）３２例，胃溃疡（ＧＵ）１０例，轻度浅表性胃炎（ＣＳＧ）２３例及正常对照者３６例的空腹血浆生长抑素（ＳＳ），血管活性肠肽（ＶＩＰ），胃动素（ＭＴＬ）及促胃液素（Ｇａｓ）的变化，并结合各疾病组的内镜特点，分析ＣＧＭＬ与某些ＧＩＨ的关系．结果血浆ＳＳ水平（ｎｇ／Ｌ）在ＣＧＭＬ及ＧＵ组分别为４１２±２１２及３７６±１４３，与正常对照组（６１２±１７０）、ＬＣ组（６６２±３０９），ＣＳＧ组（６４８±３９１）比较，Ｐ均＜００１；ＶＩＰ浓度（ｎｇ／Ｌ）则在ＣＧＭＬ组（６３４±３５８）、ＧＵ组（１１０９±４２４）、ＬＣ组（７７８±４２６）及ＣＳＧ组（６３４±３４７）均高于正常对照组（３２７±１４４），Ｐ均＜００１．ＣＧＭＬ，ＧＵ及ＣＳＧ具不同的内镜特点；ＣＧＭＬ的发病与食管静脉曲张（ＥＶ）关系密切，随ＥＶ程度的加重，发病率有增高的趋势．结论ＣＧＭＬ发病与门脉高压关系密切，激素代谢紊乱可能通过影响内脏血流及粘膜抗损害能力而参与其形成．     

一次口服单硝酸异山梨酯对心力衰竭患者的急性血液动力学效应

对９他心力衰竭患者（冠心病４例，高血压性心脏病１例，扩张型心肌病４例）一次口服单硝酸异山梨酯２０ｍｇ后，采用有创检查观察急性血液动力学效应，发现用药后半小时显效，１小时效应达高峰时，平均肺动脉压，肺毛细血管嵌压分别从服药前的４．６５±１．１７ｋＰａ（３４．９±８．８ｍｍＨｇ），２．８１±０．９２ｋＰａ（２１．１±６．９ｍｍＨｇ）降至３．００±１．０３ｋＰａ（２２．５±７．７ｍｍＨｇ）及１．７６±０．５４ｋＰａ（１３．２±４．１ｍｍｇ，Ｐ＜０．００１），中心静脉压从１．１９±０．６２ｋＰａ（８．９±４．７ｍｍＨｇ）降至０．６９±０．４６ｋＰａ（５．２±３．５ｍｍＨｇ，Ｐ＜０．０１），肺血管阻力由２９，２２±１４．８９ｋＰａ·ｓ／Ｌ降至１６．９６±８．６６ｋＰａ·ｓ／Ｌ（Ｐ＜０．０１）。药物最大效应持续至少６小时。在服药后０．５～２小时，平均动脉压明显下降（Ｐ＜０．０５）。心率无变化。一次口服未见副作用。提示单硝酸异山梨酯是治疗心力衰竭有前途的新药。     

胃癌及消化性溃疡患者胃窦粘膜胃肠激素的变化

目的探讨胃癌及消化性溃疡（ＰＵ）患者胃窦粘膜胃肠激素变化的意义．方法内镜及活检确诊的浅表性胃炎（ＣＳＧ）１０例，胃溃疡（ＧＵ）１５例，十二指肠溃疡（ＤＵ）１２例，胃癌（ＧＣ）６例．胃镜下取胃窦粘膜，用ＲＩＡ法测定胃泌素（Ｇａｓ）、生长抑素（ＳＳ）、Ｐ物质（ＳＰ）的含量，各组间进行比较．结果胃窦粘膜ＳＳ含量在ＧＵ，ＤＵ，ＣＳＧ，ＧＣ组分别为２５１ｐｇ／ｍｇ±１９４ｐｇ／ｍｇ（以下同），４７０±１７９，５３２±２１１及１２９３±５２３。其中ＧＵ组低于其余各组（Ｐ＜００５），而ＧＣ时则显著升高（Ｐ＜００１）．ＳＰ含量在ＤＵ组显著降低，与ＧＵ，ＣＳＧ，ＧＣ比较分别为４７９±１５７ｖｓ７６５±４１５，７８９±３９０及８０１±３４６，Ｐ＜００５；ＧＣ患者Ｇａｓ水平显著高于ＣＳＧ组，为４６４５±２９４４，ｖｓ２７６８±１５７２，Ｐ＜００１．结论胃粘膜中Ｇａｓ，ＳＳ，ＳＰ含量的变化可能在ＰＵ及胃癌的发病机理中起重要作用．     

冬虫夏草多糖治疗慢性丙型肝炎患者的临床研究

目的研究冬虫夏草多糖（ＣＰ）治疗慢性丙型肝炎的疗效．方法慢性丙型肝炎患者２１例，口服ＣＰ１５ｍＬ，３次／ｄ，连服３ｍｏ，治疗前后检测肝功能、血清肝纤维化标志物外周血Ｔ细胞亚群及ＮＫ活性的变化．结果慢性丙型肝炎患者经ＣＰ治疗后，血清ＡＬＴ（Ｕ／Ｌ，６１±３５ｖｓ３５±１５）及ｒＧＴ（Ｕ／Ｌ，１６９±８５ｖｓ１１８±５２）较治疗前显著降低（Ｐ＜００５）．血清ＨＡ（μｇ／Ｌ，２９３±１０９ｖｓ２１４±９６）、ＰⅢＰ（μｇ／Ｌ，１４３±４８ｖｓ１１４±４２）及ＣⅣ（μｇ／Ｌ，２４５±９８ｖｓ１８８±８７）均较治疗前显著下降（Ｐ＜００１，＜００５及＜００５）；ＣＤ４（３６４％±６６％ｖｓ４１０％±５６％）、ＣＤ４／ＣＤ８（１１４±０４０ｖｓ１４３±０２２）、ＮＫ（１６７％±４６％ｖｓ１９７％±４２％）均较治疗前显著增加（Ｐ＜００１），而ＣＤ８（３２６％±４７％ｖｓ２８９％±３７％）则明显降低（Ｐ＜００５）；血清胆红素略减、清蛋白略增但差异均无显著性．结论冬虫夏草多糖可以增强慢性丙型肝炎患者细胞免疫功能，改善肝功能，并具有一定的抗纤维化作用     

月见草油治疗十二指肠溃疡的研究

目的研究月见草油对十二指肠溃疡（ＤＵ）的治疗作用．方法选经内镜确诊为ＤＵ的住院患者１２０例，随机分为治疗组（ｎ＝６０）和对照组（ｎ＝６０）．治疗组服用月见草油１５ｇ，４次／ｄ，对照组服用西味替丁２００ｍｇ，４次／ｄ，两组均为４周１疗程．治疗前及治疗４周后各做胃镜１次，观察溃疡的愈合情况，同时，治疗前及治疗４周后用放免法分别测定血浆内的ＰＧＥ２含量．结果治疗组与对照组患者的消化道症状均较服药前明显减轻（Ｐ＜００１），两组间无显著性差异（Ｐ＞００５）．４周溃疡愈合率和有效率，治疗组为７６６％和８６６％，对照组分别为７００％和８３３％，两组间无显著性差异（Ｐ＞００５），对照组于治疗前后血浆ＰＧＥ２水平无显著性差异，而治疗组于治疗前后的血浆ＰＧＥ２水平却有显著性差异（９４５ｎｇ／Ｌ±３７ｎｇ／Ｌ→１７２３ｎｇ／Ｌ±５７ｎｇ／Ｌ，Ｐ＜００５）．结论月见草对ＤＵ的近期疗效较好，可用于治疗ＤＵ．     

Large Lipomatous Hypertrophy of the Interventricular Septum

We present the case of a 58-year-old woman who had large lipomatous hypertrophy of the interventricular septum, a condition that is reported very infrequently. Preoperative cardiac magnetic resonance images revealed an inhomogeneous, infiltrating mass that was suppressed in fat-suppression mode. The extensive mass was causing right ventricular dysfunction, so we excised it through a right ventricular approach. The findings on histologic analysis of the mass were consistent with lipomatous hypertrophy. The patient died of septic shock on the 28th postoperative day. In addition to the patient''s case, we discuss the characteristics and diagnosis of this rare entity.     

Resolution of Right-Sided Heart Failure Symptoms after Resection of a Primary Ovarian Carcinoid Tumor

Carcinoid tumors are rare neuroendocrine malignancies that typically originate from the gastrointestinal tract. Patients who are diagnosed with carcinoid heart disease generally have poor prognoses because of advanced metastases during staging and few therapeutic options. We present the case of a 61-year-old woman with right-sided heart failure, secondary to carcinoid heart disease caused by a primary ovarian carcinoid tumor. After undergoing surgical resection of the left ovary and fallopian tube, the patient experienced complete resolution of her heart failure symptoms. In addition to the patient''s case, we discuss the diagnosis, nature, and treatment of this rare condition.     

Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

In the modern period of reperfusion, left ventricular free-wall rupture occurs in less than 1% of myocardial infarctions. Typically, acute left ventricular free-wall rupture leads to sudden death from immediate cardiac tamponade. We present the case of a 59-year-old woman who sustained a posterior-wall myocardial infarction and subsequent cardiac arrest with pulseless electrical activity. A bedside transthoracic echocardiogram showed pericardial effusion with cardiac tamponade. Emergency pericardiocentesis yielded 500 mL of blood, and spontaneous circulation returned. Contrast-enhanced echocardiograms revealed inferolateral akinesis and a new, small myocardial slit with systolic extrusion of contrast medium, consistent with left ventricular free-wall rupture. During immediate open-heart surgery, a small hole in an area of necrotic tissue was discovered and repaired. This case highlights the usefulness of bedside contrast-enhanced echocardiography in confirming acute left ventricular free-wall rupture and enabling rapid surgical treatment.     

Conservative Management of Cardiac Hemangioma for 11 Years

Cardiac hemangiomas are benign tumors with an unpredictable natural history. Surgical resection is the treatment of choice; however, conservative management can be an alternative in some patients.We report a case of a left-sided cardiac hemangioma that we managed conservatively for 11 years without obvious major complications in the patient, an adult woman.     

Benefits and Limitations of Multimodality Imaging in the Diagnosis of a Primary Cardiac Lymphoma

Primary cardiac tumors are far rarer than tumors metastatic to the heart. Angiosarcoma is the primary cardiac neoplasm most frequently detected; lymphomas constitute only 1% of primary cardiac tumors.We present the case of a 55-year-old woman with a recently diagnosed intracardiac mass who was referred to our institution for consideration of urgent orthotopic heart transplantation. Initial images suggested an angiosarcoma; however, a biopsy specimen of the mass was diagnostic for diffuse large B-cell lymphoma. The patient underwent chemotherapy rather than surgery, and she was asymptomatic 34 months later.We use our patient''s case to discuss the benefits and limitations of multiple imaging methods in the evaluation of cardiac masses. Certain features revealed by computed tomography, cardiac magnetic resonance, and positron emission tomography can suggest a diagnosis of angiosarcoma rather than lymphoma. Cardiac magnetic resonance and positron emission tomography enable reliable distinction between benign and malignant tumors; however, the characteristics of different malignant tumors can overlap. Despite the great usefulness of multiple imaging methods for timely diagnosis, defining the extent of spread and the hemodynamic impact, and monitoring responses to treatment, we think that biopsy analysis is still warranted in order to obtain a correct histologic diagnosis in cases of suspected malignant cardiac tumors.     

Effects of hypoxia, hyperoxia on the regulation of expression and activity of matrix metalloproteinase-2 in hepatic stellate cells

AIM To study the effects of hypoxia,hyperoxia on theregulation of expression and activity of matrixmetalloproteinase-2 (MMP-2) in hepatic stellate cells(HSC).METHODS The expressions of MMP-2,tissue inhibitor ofmatrix metalloproteinass-2 (TIMP-2) and membrane typematrix matalloproteinass-1 (MT1-MMP) in cultured rat HSCwere detected by immunocytochemistry (ICC) and in situhybridization (ISH).The contents of MMP-2 and TIMP-2 inculture supernatant were detected with ELISA and theactivity of MMP-2 in supernatant was revealed byzymography.RESULTS In the situation of hypoxia for 12h,theexpression of MMP-2 protein was enhanced (hypoxiagroup positive indexes:5.7±2.0,n=10;control:3.2±1.0,n=7;P<0.05),while TIMP-2 protein was decreasedin HSC (hypoxla group positive indexes:2.5±0.7,n=10;control:3.6±1.0,n=7;P<0.05),and the activity(total A) of MMP-2 in suparnatant declined obviously(hypoxla group:7.334±1.922,n=9;control:17.277±7.424,n=11;P<0.01).Compared the varied duration ofhypoxia,the changes of expressions Including mRNA andprotein level as well as activity of MMP-2 were mostnotable in 6 h group.The highest value (Ahypoxla~-Acontrol) ofthe protein and the most intense signal of mRNA were inthe period of hypoxia for 6 h,along with the lowestactivity of MMP-2.In the situation of hyparoxia for 12 h,the contents (A_(450)) of MMP-2 and TIMP-2 in supernatantwere both higher than those in the control,especially theTIMP-2 (hyperoxla group:0.0499±0.0144,n=16;control:0.0219±0.0098,n=14;P<0.01),and so wasthe activity of MMP-2 (hyperoxia group:5.252±0.771,n=14;control:4.304±1.083,n=12;P<0.05),and the expression of MT1-MMP was increased.CONCLUSION HSC is sensitive to the oxygen,hypoxiaenhances the expression of MMP-2 and the effect is moremarked at the early stage;hyperoxia mainly raises theactivity of MMP-2.     

Unusual Presentation of Listerial Myocarditis and the Diagnostic Value of Cardiac Magnetic Resonance

Listeria monocytogenes is an infrequent cause of bacterial myocarditis. Myocarditis without evidence of endocarditis is even rarer. Management in such cases involves early diagnosis, antibiotic therapy, and emergency treatment of arrhythmias.We report the case of a 47-year-old man who presented with features of acute ST-segment-elevation myocardial infarction complicated by ventricular tachycardia that necessitated urgent electrical cardioversion. Contrast-enhanced cardiac magnetic resonance images revealed hypertrophy, necrosis, and a mass that was determined to be an abscess caused by L. monocytogenes. Antibiotic treatment led to resolution of the listerial myocarditis.In addition to reporting our patient''s case, we discuss the comparative advantages of cardiac magnetic resonance versus transthoracic echocardiography in characterizing myocarditis, upon presentation and in follow-up evaluation.     

Importance of Absent Ductus Arteriosus in Tetralogy of Fallot with Absent Pulmonary Valve Syndrome

Tetralogy of Fallot without pulmonary valve syndrome is almost always associated with an absent ductus arteriosus. Patients with right aortic arch and retroesophageal left subclavian artery have a vascular ring if the left ductus arteriosus or its remnant and the Kommerell diverticulum are present. We report the cases of 2 infants in whom the role of an absent ductus arteriosus or its remnant is noteworthy. Both patients had a combination of tetralogy of Fallot with absent pulmonary valve syndrome and right aortic arch with retroesophageal left subclavian artery without a vascular ring. The absence of the ductus arteriosus has a role in the pathogenesis of tetralogy of Fallot with absent pulmonary valve syndrome. The absence of a ductus arteriosus in the right aortic arch with retroesophageal left subclavian artery precludes a vascular ring.     

Current concept of pathogenesis of severe acute pancreatitis

The pathogenesis of severe acute pancreatitis is very complicated. It is a multifactorial as well as multifaceted disease. First of all, the etiologic agents initiate the pancreatic acinar injury by release of pancreatic enzymes and overstimulation of macrophages and neutrophils, then the cytokines and inflammatory mediators are liberated. There is also interaction between neutrophils and endothelial cells producing free radicals, the cytokines cause increasing vascular permeability, activating complement component, resulting in microcirculatory impairment and imbalance of thrombo-fibrinolytic system. Many of these events occur not only in the pancreas itself, but also in the other vital organs and tissues, leading to severe acute pancreatitis and complications. The sequencial events are as follows.